Joint Royal Colleges Of Physicians Training Board Research Articles

Implementation of a high-fidelity simulation programme for year 3 internal medicine trainees (IMT3)

Year 3 Internal Medicine Trainee (IMT3) is a new (in 2021) grade of medical trainee intended to bridge the chasm between the supported environment of being a senior house officer and the more independent role of a medical registrar. We identified an unmet need for simulation experience to develop skills in emergency management, team leadership, and medicolegal/ethical judgement needed by the medical registrar [1]. Medical simulation and human factors training are essential for the development of IMT3s [2]. We created a novel high-fidelity simulation programme to address this training requirement and support this new grade of junior registrars. We designed five scenarios according to current curriculum guidance and Trust human factors framework. These scenarios were: (i) managing a Jehovah’s witness with an upper gastrointestinal tract bleed but lacking capacity, (ii) tricyclic antidepressant overdose, (iii) cardiac arrest in pregnancy, (iv) duty of candour after a fatal medical error, and (v) a hypoxic COVID-19 patient refusing treatment. The scenarios were piloted to a focus group with iterative improvements made. Participants responded to a Likert-type scale on both pre- and post-course questionnaires regarding their perceived confidence in managing difficult clinical and ethical conundrums, and their ability to share decision-making and communicate effectively during these situations. 23 out of 30 (77%) of the Trust’s IMT3s attended the programme which ran from January to May 2022, 22 (96%) of whom have completed both pre- and post-course questionnaires across the six sessions held. Mean course satisfaction and subjective knowledge gained ratings amongst participants following attendance at the course was 4.9/5. There was a 34.9% increase in mean confidence rating towards the management of challenging ethico-legal dilemmas (pre- versus post-course: 6.6/10 versus 8.9/10). Similarly, the average confidence towards the delivery of effective resuscitation in acutely deteriorating patients rose from 7.3 to 8.8/10 (20.5%), while average confidence in sharing decision-making and effective communication increased from 7 to 9/10 (28.6%) amongst the participants. Unclear audio system and lack of handouts were reported as limitations. Pauses in study leave access due to COVID-19 surges posed a challenge to the delivery of sessions and additional sessions were instituted to limit this impact. This is a novel programme for a new grade of doctors. The pilot data suggested that the implementation of a high-fidelity simulation programme appeared to be an effective modality to support the progression of this junior medical registrar cohort. 1. Joint Royal Colleges of Physicians Training Board (JRCPTB). Internal Medicine Training (IMT) Stage 1 ARCP Decision Aid. 2019 (last updated 2022). [Accessed on 4/06/2022]. 2. Joint Royal Colleges of Physicians Training Board (JRCPTB). Rough Guide to Internal Medicine Training: Guidance for training programme directors, supervisors and trainees. 2019 (last updated June 2019) guide to IMT June 2019.docx %282%29.pdf [Accessed on 17/05/2022].

Use of a short trainee questionnaire to support international UK equivalent core medical training.

The Federation of the Royal Colleges of Physicians of the UK provides UK equivalent Core Medical Training (CMT), now Internal Medicine Training (IMT), with six partners internationally. The objective of this study was to support the quality management and accreditation of those programmes. A short, simple trainee questionnaire was designed and implemented online to produce data that could be compared with the Joint Royal Colleges of Physicians Training Board (JRCPTB) analysis of the UK national General Medical Council (GMC) questionnaire. Survey included first three of the current six international partners of JRCPTB: one site in Iceland and the other two in India. Over 90% trainee engagement was achieved, and the results are compatible and related to the UK experience. No serious issues were identified that need immediate action and the output was used for discussion about training and service at all three sites. Good satisfaction with the programme was found in all three sites. A simple online questionnaire can have good engagement with trainees on an international basis and produce useful information that helps trainees and trainers discuss the care of their patients and improve training.

A UK-wide survey looking at teaching and trainee confidence in teledermatology: a vital gap in a COVID-19-induced era of rapid digital transformation?

SummaryTeledermatology has had an explosive impact on the provision of dermatology services in recent times, and even more so with the unprecedented situation created by the COVID‐19 pandemic. Although teledermatology is not presently a feature of the Joint Royal Colleges of Physicians Training Board (JRCPTB) curriculum for dermatology training, this is due to change imminently. Specialty trainees need training in this area to be able to confidently and competently meet the demands of the changing face of dermatology services. We surveyed dermatology registrars in training across the UK, prior to the outbreak of COVID‐19, to ascertain the teledermatology teaching available and trainee confidence in this area. Our survey found that only 15% of respondents felt slightly confident in their ability to deal with teledermatology referrals and almost all (96%) felt more teaching was needed.

Development of a GMC aligned curriculum for internal medicine including a qualitative study of the acceptability of ‘capabilities in practice’ as a curriculum model

The Shape of Training review and the General Medical Council (GMC) requirements in demonstrating generic professional capabilities were major drivers for the Joint Royal Colleges of Physicians Training Board (JRCPTB) to develop the new internal medicine curriculum. In particular, the GMC required progression to a more outcomes-based curriculum. The present curricula for physician training are based on demonstrating a large number of individual competencies that are assessed by a variety of different methods. It was felt that current system was overwhelming and had become a 'tick box' exercise. The new curriculum is based on a much smaller number of outcomes, called capabilities in practice, which reflect the key professional work activities of a fully trained physician. The aim is to re-emphasise the role of professional judgement in 'trusting' the work a trainee does and thus make assessment more realistic and meaningful for both trainees and trainers. The proof of concept study explored the feasibility of using this outcomes-based model of assessment in a UK NHS setting. The learning from the study has enabled us to make significant changes to the internal medicine curriculum. The GMC has recently approved the curriculum and the JRCPTB is implementing the programme from August 2019.

Quality criteria for Core Medical Training: a resume of their development, impact and future plans.

In 2015 the Joint Royal Colleges of Physicians Training Board (JRCPTB), acting on behalf of the three UK Royal Colleges of Physicians, launched a set of quality criteria designed to improve the educational experience of Core Medical Trainees. The criteria were developed with key stakeholders from Core Medical Training (CMT) and monitored via the General Medical Council's annual National Training Survey. This paper describes the development, implementation and impact of these criteria, which have been implemented by UK postgraduate schools of medicine since 2015. There were trainee-reported improvements from baseline (2015-18) in at least eight out of the 13 core criteria measured. The results demonstrate that a coordinated UK-wide approach to quality improvement, focused on a specific set of clearly defined and measurable outcomes that galvanise trainer engagement, can lead to greater trainee satisfaction in a demanding area of medicine without significant additional resources.

The medical unit round: engaging trainees in curriculum-relevant teaching

To provide weekly curriculum-relevant teaching for medical juniors as per Joint Royal Colleges of Physicians Training Board (JRCPTB) quality criteria for core medical trainees. Previous attempts at establishing sustainable weekly medical teaching at our hospital had failed secondary to poor attendance from both trainees and consultants. At the beginning of the year, the Royal College of Physicians college tutors, associate college tutors and chief registrar agreed that re-establishing high quality weekly teaching was a high priority …

Use of an accreditation process to embed UK-equivalent Core Medical Training in an international context.

The Joint Royal Colleges of Physicians Training Board (JRCPTB) on behalf of the Federation of the three Royal Colleges of Physicians started a process of implementing UK-equivalent Core Medical Training internationally in 2014. An accreditation process was developed to ensure that training standards were at least equivalent to the current position in the UK and that a developmental process was embedded to ensure long-term program viability. This paper describes developing the appropriate standards, the types of accreditation being offered and the process of a full accreditation visit. The outcomes and learning from the first three accreditation visits, two visits to Iceland and the first to Kochi in Kerala, India, are described. Significant improvement over time has been demonstrated in Iceland as well as very high standards of training in Kerala. The accreditation process is providing early evidence that UK-equivalent Core Medical Training can be delivered successfully in different international contexts. The findings emphasise the importance of externality as part of effective governance. Partners need to be carefully chosen with a high degree of commitment to the process of both implementation and ongoing development. Longer term evaluation will need to consider other dimensions, such as exam results, and trainee and trainer satisfaction.

Shaping the future of Acute Medical training

Sir, I read with interest the Viewpoint article by Dr Chadwick regarding the future of Acute Internal Medicine (AIM) training, particularly the development of Capabilities in Practice (CiPs) and their potential to promote a greater identity within the specialty training. Dr Chadwick highlights the struggle we face in asserting why our specialty is so vibrant and vital. In my experience, Acute Internal Medicine training suffers from an identity crisis whereby the specialty is seen as being permanently on call, with trainees working more shifts as the Duty Medical Registrar (DMR) than on other specialty training programs, without the variability of outpatient and skill-based training. Indeed, the recent Joint Royal Colleges of Physicians Training Board (JRCPTB) statement regarding quality criteria for GIM/AIM Registrars appears to regard the role of the AIM registrar as that of the DMR rather than a specialist in their own field.

Core medical training needs “urgent” reform to drive up quality, says RCP

Urgent changes are needed to improve the quality of core medical training (CMT), a report by the Royal College of Physicians (RCP) and the Joint Royal Colleges of Physicians Training Board (JRCPTB) has suggested. The report found that CMT trainees were spending too much time providing services and not enough time receiving training. It also raised concerns that trainees were often not able to attend outpatient clinics and training sessions, and that many did not receive enough feedback from senior colleagues. The RCP carried out a survey in June last year of junior doctors undertaking CMT, and received responses from 779 trainees. In a report on the survey, the RCP warned the findings suggested that, if CMT were not improved, recruitment to the programme would “continue to decrease” and it would become increasingly difficult to recruit to medical specialties.1 “Urgent changes must be made to improve the quality of training for CMT trainees who are the future consultants of our medical workforce,” the report said. In total, 91% of respondents to the survey said that they had spent 80% to 100% …

Dermatology training in the U.K.: does it reflect the changing demographics of our population?

Funding sources: Funding for this study was provided by London Ethnic Skin Limited. Dear Editor, The U.K. has seen an increase in the proportion of the ‘nonwhite’ population by 61% between 2001 (8·7%) and 2011 (14%), with the proportion of black Africans doubling over this period.1 Studies have shown that among different ethnic and racial groups, cutaneous disorders may vary in both prevalence and clinical manifestation.2 In light of this, as well as the observed changes in the U.K. demographics, it is important that dermatologists are adequately trained to diagnose and manage dermatoses pertinent to our ethnic population. For this reason, we conducted a questionnaire‐based study to ascertain whether the current U.K. dermatology training programme for specialist registrars provides adequate training in the diagnosis and management of diseases pertinent to the ethnic population. We identified 217 dermatology trainees (specialty training level ST3–ST6, including those out of programme) and 77 junior consultants (within 2 years of receiving their Certificate of Completion of Specialist Training) from the database of the U.K. Joint Royal Colleges of Physicians Training Board (JRCPTB) as being eligible for inclusion into the study. A web link to our online questionnaire was sent to this target group via: (i) the monthly e‐mail bulletin of the British Association of Dermatologists (BAD); (ii) letters posted to all National Health Service hospitals with a dermatology department in the U.K.; and (iii) an e‐mail bulletin distributed twice to dermatology trainees via regional trainee representatives.

Assessing the accuracy and certainty in interpreting chest X-rays in the medical division

The chest X-ray (CXR) is an important diagnostic tool in diagnosing and monitoring a spectrum of diseases. Despite our universal reliance on the CXR, our ability to confidently diagnose and accurately document our findings can be unreliable. We sought to assess the diagnostic accuracy and certainty of making a diagnosis based on 10 short clinical histories with one CXR each. We conclude from our study that specialist registrars (StRs) and consultants scored the highest marks with the highest average certainty levels. Junior trainees felt least certain about making their diagnosis and were less likely to be correct. We recommend that StRs and consultants review all the CXRs requested to ensure accuracy of diagnosis. There also needs to be discussion with the Joint Royal Colleges of Physicians Training Board (JRCPTB) about the need of including a separate CXR competency as part of a trainee's generic curriculum on the e-portfolio, something which is currently lacking.

Integrating pharmacology and clinical pharmacology

I here reaffirm some of the points that I made in the manifesto for UK clinical pharmacology [1], in response to letters from others. Much of what I wrote in the manifesto addresses points that correspondents have made, but as some of the important points may not have been clear on a first reading, I shall reiterate them and add clarifications. I am surprised that Professor Page [2] should think that I have taken no cognizance of the erosion of the discipline of pharmacology in recent years. Nothing that I said, wrote or did, while I was President-Elect and President of the British Pharmacological Society (BPS) during 2006 to 2009, should have given that impression. If he doubts this, and my commitment to the integration of all pharmacological science across the clinical and non-clinical spectra, he may want to reread some of my articles in the newsletter of the BPS, previously called pA2, now called Pharmacology Matters[3, 4], and indeed the manifesto itself, where I wrote that ‘the importance of integrating pharmacology and clinical pharmacology cannot be overestimated’. In relation to this, I strongly believe that the distinction that many make between basic and applied science is a false dichotomy. As I wrote in the manifesto, ‘functions in biology emerge … as a result of integration of different components of relevant systems at different levels.’ This is true of pharmacology and clinical pharmacology. Although it is sometimes useful to refer separately to basic and applied science, it is the crosstalk between them, at all levels and from one level to another, that is important. I have recently had the opportunity to make these views known more widely, in my opening plenary lecture at WorldPharma 2010, the 16th World Congress of the International Union of Basic and Clinical Pharmacology (IUPHAR). The contents of that lecture have been posted on the BPS's website [5].