Training in general internal medicine: what do trainees want and what can we deliver?

General internal medicine (GIM) training, usually as part of a dual accreditation programme, is increasingly challenging to deliver as a result of increased numbers of acute admissions, changes to consultant input into medical 'on call' and the reduction in the numbers of units taking unselected medical patients. GIM has become synonymous with acute medical take, reducing the scope of programmes to deliver a true general medical experience. The role of the 'medical registrar' is reported to be increasingly unpopular with trainees. Differing models of the delivery of training are in place. We have carried out a two-stage questionnaire in order to determine the views of both trainees and trainers on different models of training and their deliverability. The first stage defined the key areas of concern for trainees and the second focused on these areas and the ability of local education providers to deliver an expanded GIM programme. Our data suggest that trainees would value a face-to-face annual review of competence progression (ARCP) for GIM, separate from their specialty ARCP, and would support more structured blocks of GIM training in order to allow later specialty-focused training. However, -significant concerns were raised about the ability of many units to deliver such training beyond the acute medical 'take'.

Professional Support, London: the professional development unit supporting practitioner well-being, refreshment, remediation and revalidation.

London' s Professional Support Unit (PSU) was launched in April 2012 at a time when changes and financial pressures across the health service were placing considerable demand on the medical and dental workforce. At the same time the infrastructure to support medical revalidation was established. The PSU provides developmental support to clinicians across London in all career grades and specialities, to sustain and restore them to contribute effectively to health service delivery across the capital. The costs of medical training are high. Maintaining doctors at work has to be cost effective. Clinicians in multicultural London require diverse resources, as increasing numbers have trained abroad. The PSU offers a holistic, tailor-made approach to professional and personal development with a range of resources and approaches. It provides proven high quality educational interventions, creating a linked and integrated service, providing clinicians with new opportunities. Access is by self-referral with resources targeted at those going through transitions in their professional lives, as well as those who have specific developmental needs. A collaborative approach across the PSU and its education and governance communities ensured the provision of personal support to over 1300 clinicians in its first year, together with interdisciplinary group learning opportunities. Online materials were created to assist individuals, workplace groups and a broad network of support and expertise. To maximise the effectiveness of the service, learning events were also held for those working within the PSU. In commending the PSU and its positive impact, the General Medical Council has recommended the model be shared nationally. At the same time the London's three Local Education Training Boards have recommended that the PSU expand to encompass a more diverse range of professional groups. Our challenge is how to extend such flexible, responsive and values-based support across the workforce, given stringent financial pressures.

The Induction and Refresher scheme Simulated Surgery.

The Induction and Refresher scheme Simulated Surgery (I&RSS) is an assessment of clinical and consulting skills in which candidates are observed consulting with a series of simulated patients who present a variety of common GP scenarios. The Committee of GP Education Directors (COGPED) recommends a period of induction for GPs returning to practice after a time away and GPs from the European Union wishing to enter UK general practice. In some deaneries the Induction and Refresher scheme is also the means by which GPs with fitness to practise concerns can be remediated back into the workplace. The I&RSS is used by English deaneries to assess their learning needs prior to entry into the scheme. This paper describes the I&RSS and its validity and reliability. We explain how it differs from the MRCGP Clinical Skills Exam and how it provides formative feedback to candidates. We report on the outcomes of the exam for the last two years and discuss the performance of different candidate groups.

GP trainees and revalidation.

GP trainees surveyed GP trainees in the London Deanery to ask their views about revalidation, and have found there are significant perceived deficiencies in knowledge, engagement, and faith in plans.