Introduction To Higher Specialist Training
Individual specialties and information on the rotations involved are described under each specialty and these sections have been written by the relevant Training Programme Director or another consultant on the Training Committee who has been designated by them for this task. All the training programmes involve rotations through different hospitals in the school to provide experience in both District General Hospital and Regional Centre settings. Study days are organised by the Training Programme Directors and attendance at an agreed proportion of these meetings is mandatory.
The study day programme for General Medicine is also compulsory for all specialties involving dual accreditation and these are organised by the Acute Medicine TPD, Dr Nabil Jarad, Respiratory/ General Physician Bristol Royal Infirmary.
A few rotations, notably Respiratory and Renal medicine, are run jointly with the Peninsula School to provide trainees in both schools with the best opportunities to gain experience in sub specialty fields in Regional Centres. For these one School acts as the lead for the specialty with their Training Programme Director taking overall responsibility for the specialty and another consultant in the other school acting as their deputy.
More senior trainees who were appointed as SpR’s in the Calman system will continue to be reviewed by the RITA process and continue their RITA portfolios. New higher specialty trainees entering ST3 from core training will be assessed by the ARCP system and will continue to use their e-portfolios following on from the entries made in Core Training.
Principles of Higher Training
The duration of Higher training varies with the medical specialty involved and one of the concepts of MMC is that it is competency based so that more able candidates may succeed in completing their training and receiving their Certificate of Completion of Training (CCT) earlier than their peers. From 2008 onwards higher training also involves passing an examination in the specialty. These examinations are just being set up in most specialties and generally involve a knowledge based test as opposed to the clinical skills and competencies that are documented through e-portfolios and review each year at ARCP. While we do not have detailed knowledge yet on all specialties it appears that most specialties will decide that this examination can be taken at any time during higher training and it will be possible to retake it if not initially successful but the CCT can not be awarded until it has been passed.
Our understanding at present is that current Calman SpR’s will have the option to sit these examinations if they wish but they will not be compulsory.
The curriculum for each specialty is determined by the individual specialist society, e.g. The British Thoracic Society gives guidance on the curriculum for Respiratory Medicine, and then this is further monitored and updated by a national Specialist Advisory Committee (SAC) for each specialty which reports to JRCPTB. The national SAC for each specialty has representatives on it from all the Schools of Medicine in the country and these people are usually the Training Programme Directors for the specialty in their local School.
For the specialty of Acute Medicine, the Certificate of Completion of Training (CCT) is awarded at an earlier stage than for training in other medical subspecialties and many of them, e.g. Respiratory Medicine, normally involve accreditation in both acute medicine and the specialty. There are curricula which set three competency levels for acute medicine. Details of these can be downloaded from the JRCPTB website - JRCPTB
Level 1 is achieved during completion of core medical training. The competency level for the Acute medicine component in dual accreditation is level 2. This level of competence is required for a consultant in a specialty e.g. gastroenterology, who also participates in the acute take. For those training in acute medicine alone and who aim to become consultant acute physicians in charge of a Medical Admissions Unit level 3 competency in acute medicine is required.