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A new curriculum for Geriatric Medicine specialist trainees has been written and presented to the Postgraduate Medical Education and Training Board.

We are awaiting final confirmation on what amendments will be required but the comments below about the major changes to the curriculum below are unlikely to be affected.

PMETB has expanded its standards for medical curricula to 17 and has asked for curricula to be brought up to these standards by 2010. Introduction is for those starting higher specialty training in August 2010. It is important that all trainers and specialty trainees starting in 2010 are aware of the important changes so that they can update what they teach and learn respectively.

These changes are in addition to those important changes brought in with the arrival of specialty registrars (StRs) in 2007 such as workplace based assessment for registrars, the Specialty Certificate Examination (SCE) and the e-portfolio with which many of us will now be becoming familiar.

The additional standards require further evidence on the validity of the assessment methods particularly the “high stakes” examinations such as MRCP and the SCE.

Standards for supervisors, assessors and examiners
There is increased emphasis on the standards expected of educational supervisors, assessors and examiners in supervision, assessment and giving feedback.

Certificates of Eligibility for Specialist Registration (CESRs)
Trainees who start after ST1 will not be able to obtain a CCT but will be able to obtain a CESR via an accelerated CESR route. Details at www.pmetb.org.uk

Dual recognition in G(I)M and Geriatric Medicine returns
Importantly StRs will again be able to obtain dual CCTs in Geriatric and General Internal Medicine (G(I)M which many were unhappy to lose with the arrival of the single CCT in 2007. A new curriculum for General Internal Medicine has been written and existing trainees not on dual training will be able to “map across” to the dual CCT programme by applying to the Joint Royal College of Physicians Training Board (JRCPTB) and going through a deanery based review of their “Acute Medicine” training to identify any gaps that need filling. More details of this process can be found on the JRCPTB website. In future all Geriatric Medicine trainees will be expected to dual train in G(I)M.

Stroke training
There is a considerably expanded core stroke training grid for all trainees to reflect the increased knowledge and skills required for managing stroke patients. For those trainees wishing to achieve CCT level training in stroke, an additional year of fulltime stroke training will be required which will result in a 6 year training programme for these people. There is a separate curriculum for stroke CCT level trainees.

Core competences
The former generic curriculum for physicians has now been integrated into the Geriatric Medicine curriculum in the form of core competences. As all Geriatric Medicine trainees will be expected to dual train in G(I)M, trainees will be glad to hear that the core competences for the two specialties are identical. However, in order to cover the additional core competences of leadership (the importance of which was emphasised by Lord Darzi) and because of the importance of service development in Geriatric Medicine, a new grid on “Evaluation of performance and developing and leading services” is included. An increased emphasis on health inequalities, especially ageing, is evident throughout the curriculum.

Additional core grids
With the arrival of national dementia strategies, a new grid on dementia is included. PMETB insists that anything that is assessed or examined should be found in the curriculum. The new curriculum contains additional grids on homeostasis (including fluid balance and temperature regulation), nutrition and tissue viability, all of which emphasise the importance of these topics for geriatricians. In order to recognise the fact that in most areas continuing care has moved to community settings, the continuing care and community with intermediate care grids have been merged.

Optional higher level grids
Recognition of the additional knowledge required of geriatricians who develop a special interest is now acknowledged in the curriculum. Optional grids which detail the additional experience and knowledge required in some of these areas are now included in the curriculum: orthogeriatrics and bone health; falls and syncope; movement disorders; dementia and psychogeriatric services; continence and community with intermediate care. These grids have been produced by senior members of the relevant sections or special interest groups of the BGS. The additional training required is expected to be obtained during experience “out of programme” which requires prospective approval for the individual trainee by PMETB after approval by the programme director (deanery) and JRCPTB.

Flexibilities remain
The curriculum retains the flexibilities for trainees making good progress to count up to one year out of programme following prospective approval towards their training. Out of programme experience could be in research, education or management to Masters level, a related specialty such as neurology, renal medicine, oncology or in one of the special interest areas referred to above.

A new ARCP decision grid
The increased emphasis on workplace based assessments, the SCE and the incorporation of the core competences requires a new decision grid to use at annual reviews of progress with training. This grid will rapidly become of everyday importance to all trainees and trainers. The grid is compatible with the G(I)M grid but at dual ARCPs it is still necessary to check progress against both grids. Dual recognition of appropriate workplace based assessments is still allowed, saving unnecessary duplication. The new workplace based assessments e.g. CbD, AA (audit assessment) and TO (Teaching Observation) are of most value as formative rather than summative assessments.

Conclusion
The new curriculum takes account of the additional knowledge and developments in the specialty over the last few years. It also recognises to the importance of demonstration of competence through assessment. Supervisors are expected to demonstrating their competence, not only by having the necessary knowledge and teaching skills, but also in appraisal and assessment of trainees. Trainees will have to work hard throughout the training programme in order to acquire the knowledge, skills and attitudes required but also to provide the necessary evidence of this acquisition. We hope that this will mean more assurance of a high standard of care for our patients over the longer term. Finally, the curriculum is always developing as the specialty advances so there will be annual updates to recognise these changes!

Chris Turnbull
Former Secretary of the SAC in Geriatric Medicine and Chair of the Curriculum and Assessment Groups of the SAC

BGS Newsletter, February 2010
Issue 25 ISSN 1748-634000 25