Acute internal medicine

This page provides useful information on the nature of the work, the common procedures/interventions, associated specialties and other roles that may interest you.

Download transcript [1]

Watch the above video where Dr Hannah Skene MBChB, FRCP(Edin), MMedSci, SFHEA talks about her career as a consultant in AIM.

Nature of the work

Much of the work involves the immediate care of patients around the time of their admission to hospital and the initial diagnosis and treatment for up to 72 hours of all acutely presenting medical ailments. It also includes the provision of ambulatory (outpatient) care.

The spectrum of clinical problems is wide, so trainees become experts in acute aspects of all medical specialties, and gain excellent practical procedure skills. AIM trainees and consultants interact daily with colleagues from the emergency department, critical care and many other medical specialities.

An acute medical unit (AMU) is often busy and bustling and hosts a mixture of clinical pathologies and patients of all ages – it is often described as the acute care hub of the hospital.

      There's a wide range of clinical work within the specialty. Trainees will develop expertise and skills in:

• managing acute presentation of medical illness promptly
• managing medical patients in an in-patient setting
• developing new patient pathways to maximise safe, effective care in the community where feasible
• providing leadership skills within an acute medical unit
• developing multi-professional systems to promote optimal patient care
• the care of patients requiring more intensive levels of care than would be generally managed in a medical ward, usually gained from experience within a critical care unit.

Acute internal medicine was formally recognised as a specialty in 2009, having previously been a subspecialty of general internal medicine.

“Acute physicians need to have excellent clinical acumen, with a solid grounding in all medical specialties”. Consultant acute physician, Chelsea and Westminster Hospital.

Read Hannah’s story [2]

Common procedures/interventions

• lumbar puncture
• paracentesis – puncture of the wall of a body cavity (eg chest or abdomen) in order to drain off excess fluid or to obtain diagnostic material
• pleural aspiration – insertion of a small needle into the space between the lungs and the chest wall to remove fluid that has accumulated around the lung

These procedures are often needed within the first 24 hours of hospital admission. Trainees also have an opportunity to gain experience in ultrasound during their respiratory and cardiology rotation.

Associated specialties

The development of specialist skills is a mandatory part of training in the specialty. Some trainees will choose to learn a practical procedure such as echocardiography, while others will gain qualifications in management, leadership or education, and some will become involved in medical research.  The requirement to develop an additional skill or qualification is a key element of the curriculum.

AIM is distinct from emergency medicine (A&E), although specialist acute physicians should work in close collaboration with specialists in emergency medicine. There is also a close relationship with critical care, and some trainees in this field will choose AIM as their ‘base’ specialty, before acquiring dual qualification by CCT or certification with critical care medicine.

Want to learn more?

Find out more about:

• the working life [3] of someone in acute internal medicine
• the entry requirements [4] and training and development [5]
• a first-hand account of life in acute internal medicine [6]

• Pay and conditions

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  This section [7] provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.

  Find out more about the current pay scales for doctors [8], and there's more information on the BMA website [9].

  NHS employers [10] provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in acute internal medicine, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training (CCT). You will receive your CCT at the end of acute internal medicine.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  These are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
  • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the HEE local office/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the HEE local office/deanery

  The AMU is an ideal environment for teaching and training at both undergraduate and postgraduate levels. Many doctors in Acute Internal Medicine will choose to study for a postgraduate qualification in medical education allowing them to take on formal roles in education and training alongside their clinical commitments.

  SAS doctor roles

  There are also opportunities to work at non-consultant level, for example as a SAS (Specialist and Associate Specialist) doctor. SAS doctors are non-training roles where the doctor has at least four years of postgraduate training, two of those being in a relevant specialty. Find out more about SAS doctor roles [11].

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Flexible working

  A significant proportion of UK acute internal medicine trainees are undergoing flexible training on a less than full time basis. Arrangements are made between the trainee and their local education and training board (LETB).

  Academic pathways

  If you have trained on an academic acute internal medicine pathway or are interested in research there are opportunities in academic medicine. Research opportunities in AIM are many and varied and there are active research groups in a few areas around the country.

  For those with a particular interest in research, you may wish to consider an academic career in AIM. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

  Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [12]

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine [13].https://www.nihr.ac.uk/ [12]

  The Clinical Research Network [14] (CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  The acute medical unit is an ideal environment for teaching and training at both undergraduate and postgraduate levels. Many doctors in AIM will choose to study for a postgraduate qualification in medical education allowing them to take on formal roles in education and training alongside their clinical commitments.

• Job market and vacancies

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  This section provides useful information about the availability of jobs, finding vacancies and where to find out more.

  Job market information

  AIM had 257 consultants and 326 medical registrars in England (NHS Digital, 2016 [15]).

  Women make up 33% of the consultant workforce, nearly 41% of the medical registrar workforce and 34% of higher specialty trainees in the UK (2014/15 RCP census, 2016 [16]).

  As a relatively new specialty, the percentage of consultants expected to retire in the next few years is very low.

  It is difficult to get a joint academic-NHS post but there is a recognition within the medical profession that the academic base of the specialty needs to be strengthened.

  In 2016, the competition ratio for CT1/ST1 Core Medical Training including ACCS was 1.53 and for ST3 Acute Internal Medicine it was 2.03 (NHS specialty training 2016).  [17]

  Read the Centre for Workforce Intelligence’s profile of the General Internal Medicine and Acute Internal Medicine workforce. [18] NB This information is for England only.

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data [19]

  NHS Wales medical and dental workforce data [20]

  Department of Health, Social Services and Public Safety workforce information for Northern Ireland [21]

  Where to look for vacancies

  All trainees apply through the online application system Oriel [22]. You will be able to register for training, view all vacancies, apply, book interviews and assessment centres, and manage offers made to you.

  HEE local offices/deaneries will have details of training vacancies but please note that all HEE local offices/deaneries will offer new training posts in all specialties in all years.

  All jobs will be advertised on NHS Jobs [23]. The BMJ careers [24] website also advertises vacancies.

• Further information

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  Royal College of Physician [25]

  Royal College of Physicians of Edinburgh [26]

  Royal College of Physicians and Surgeons of Glasgow [27]

  Society for Acute Medicine [28]

  British Association for Immediate Care (BASICS) [29]