Introduction

Congratulations on your appointment to the training programme. This document summarises the core components of the training programme. The nature of training programmes is not fixed and can change. If you have any questions about training, please discuss this with your educational supervisor or training programme director (TPD).

Key Links

Curriculum Matters

• Palliative Medicine
  
  • All up to date documents are available at https://www.thefederation.uk/training/specialties/palliative-medicine
  • You should read and play close attention to the 2022 Curriculum, 2022 Decision Aid and the Rough Guide to Training
• Internal Medicine
  
  • All up to date documents are available at https://www.thefederation.uk/training/specialties/internal-medicine
  • You should read and play close attention to the Stage 2 Curriculum, Stage 2 Decision Aid and the IMS2 Rough Guide to Training
• ePortfolio – JRCPTB Guides, further help Zarmina.ali@nhs.net
• Gold Guide – Postgraduate Training Manual

Deanery

• Up to date information regarding programme management is at this website NHS England North West. This includes:
  
  • Supported Return to Training
  • Applying for Less than Full Time Training
  • Study Leave
  • Educator Development

Contractual and Employment Matters

• Up to date information regarding programme management is at this website Lead Employer. This includes:
  
  • Employee Hub
    
    • Absence Support
    • Wellbeing
    • Exception Reporting
    • Medical Indemnity
  • Payroll Hub
    
    • Expenses & Mileage
    • Salary Sacrifice Schemes
    • Pay Errors
    • Pensions, Tax and Total Reward Statements
  • Policies, including application forms covering:
    
    • Annual Leave
    • Flexible Working
    • New Parent Support Leave (including parental leave, adoption leave)
    • Special Leave

Contacts

Training Programme Director (NW)

Dr Kirsten Baron          Kirsten.baron@lthtr.nhs.uk     07851238024

 

Training Programme Director (Cheshire and Merseyside)

Dr Andrew Khodabukus          Andrew.khodabukus@merseywestlancs.nhs.uk            07769 084 969

Training

Dual Training

The introduction of a new dual curriculum took place in 2022. The aim is to ensure that future consultants have specialty-specific and generic skills to manage patients with acute medical conditions, complex life-limiting disease and multiple health conditions in all palliative care settings. Palliative Medicine higher specialty training will typically be completed in four years (ST4-ST7) of full-time training. Once completed, trainees will obtain a certificate of completion of training (CCT) in both Internal Medicine (IM) and Palliative Medicine. Prior to the 2022 curriculum, Palliative Medicine trainees did not complete specific IM training. The 2022 and the 2010 palliative medicine curricula are likely to both run in parallel for a number of years whilst trainees on the old curriculum finish training.

Training Programme Length

The duration of Higher Medical Training is four years for a full-time Postgraduate Doctor in Training (PgDiT) and pro-rata for those working less than full time.

The training includes both IM and Palliative Medicine placements. It is important to recognise that experience and skills are transferable and relevant to both. In total, trainees will be required to complete nine to 12 months of IM across the four years of training with a requirement for a minimum of three months in the final year (or one immersion month of acute experience, with active involvement in the care of 100 patients in either iteration).

The length of training can be longer if Postgraduate Doctors in Training take time out of programme or if training extension is needed to achieve capabilities of practice.

At the end of the programme, Postgraduate Doctors in Training achieve a certificate of completion of training (CCT). The expected date of CCT is reviewed at each ARCP.

 

Training Year Map

Palliative Medicine & Internal Medicine Regional Teaching

 

 

PM = Palliative Medicine IM = Internal Medicine

Non-PM outpatient clinic – minimum 20 during training

Types of Services and Placements:

A number of hospices, associated community specialist palliative care teams and hospital palliative care teams are accredited for Higher Medical training by the Royal College of Physicians and NHS England North West. The curriculum for palliative medicine is capability based and assessment is recorded on the e-portfolio, through regular appraisal and annual assessment.

The current training posts in Cheshire and Merseyside are based at:

1. Marie Curie Centre, Liverpool (Integrated Mersey Palliative Care team (IMPaCT) South Services, Inpatient Unit)
2. Royal Liverpool University Hospital (Hospital Specialist Palliative Care Team and Palliative Care Inpatient Unit) with On Call at Marie Curie Hospice
3. Aintree University Hospital (IMPaCT North Services, Hospital Specialist Palliative Care Team, Woodlands Hospice)
4. St Helens and Knowsley (Willowbrook Hospice, Community Services and Whiston Hospital)
5. Wirral (Wirral Hospice St John’s, Community Services and Arrowe Park Hospital including Supportive Care Unit)
6. East Cheshire (East Cheshire Hospice, Macclesfield General Hospital and Community Services)
7. West Lancashire, Southport and Formby Supportive and Specialist Palliative Care Service (Integrated service of Hospital, Hospice and Community Settings at Queenscourt Hospice).

 

The current training posts in NW are based at:

1. St Catherine’s Hospice, Preston (Hospice and Community)
2. St Ann’s Hospice, Little Hulton (Hospice and Community)
3. St Ann’s Hospice, Heald Green
4. Trinity Hospice, Blackpool
5. Wigan and Leigh Hospice, Wigan
6. Salford Royal NHS Foundation Trust (Palliative Medicine and IM)
7. Lancashire Teaching Hospitals NHS Foundation Trust
8. Christie Hospital NHS Foundation Trust
1. East Lancashire Hospital NHS Foundation Trust (Hospital and Community)
10. Manchester University Foundation Trust
11. St Catherine’s Hospice, Preston (Community)
50. St Ann’s Hospice, Little Hulton (Community)
1000. Bolton NHS Foundation Trust (Community)
14. St John’s Hospice Lancaster

Training rotations happen in August and February depending on the Postgraduate Doctor in Training’s needs. Placements are decided after review of current and past placements, based on individual training needs and requirement for programme completion and curriculum experience/sign-off.

Hospital Palliative Care Team

Usually consists of clinical nurse specialists with medical support from a consultant in Palliative Medicine. The primary role of the team is to advise other clinical staff in the Hospital on the control of pain and other symptoms, taking account of the psychosocial needs of the patients and their family. The Hospital Palliative Care Team usually works alongside the admitting team who retain named clinical responsibility. Levels of intervention may vary from telephone advice to a single visit or multiple visits to the patient.

Other roles consist of information and advice to the patient regarding their illness and treatment, liaison with family and carers including emotional support and advice, emotional support for staff caring for patients with advanced disease, education in palliative care to other staff members and linking inpatient to community based palliative care services.

Some NHS Hospitals have designated palliative care beds which are run by the Palliative Care Team, or the ongoing medical care may remain the responsibility of the original admitting Hospital team.

Hospice

This is usually a free standing unit with inpatient facilities, staffed by a multi-professional team specially trained in palliative care. The majority have consultant input and other medical staff, with specialist nursing staff and a range of other professionals such as physiotherapist, OT, pharmacist, chaplain, social worker and dietitian. Patients are usually admitted for short-term assessment for symptom control, rehabilitation, terminal care and, in some units, respite care. The hospice may be funded by local or national charities or by the NHS or in combination.

Day Therapy & Wellbeing Services

Some hospices have day therapy services that offer rehabilitation, symptom control advice, psychological support and access to complementary therapies.

Outpatient Palliative Medicine Clinics

These may be held either in a hospice, hospital or community base, led by a Consultant in Palliative Medicine. The major emphasis is on pain and symptom control but clinics also give the opportunity to introduce other palliative care services such as day therapy, inpatient facility and community specialist palliative care teams.

Other Outpatient Services available in some areas include:

• Lymphoedema
• Breathlessness Clinics
• Complementary Therapies

Specialist Community Palliative Care Teams

These usually consist of a team of clinical nurse specialists with consultant support. They work closely with primary care teams to support patients with symptom control, psychological support, advance care planning and end of life care.

Oncology, Pain and Children & Young People Transition Placements

Alongside palliative medicine and internal medicine placements, the training programme includes dedicated placements in oncology, pain and transition to offer specific experience alongside that which is obtained through the rest of the training programme. The timetable would be agreed for each trainee following discussion with their Educational Supervisor.

Oncology

Attachment will be based at Clatterbridge Cancer Centre (CCC) for Mersey Trainees, and either The Christie Hospital or Lancashire Teaching Hospitals for NW trainees. An individualised timetable would be agreed for each trainee following discussion with their Educational Supervisor. This formal placement would be complemented by oncology experience gained through palliative medicine and internal medicine training and evidence through a range of activities; working with acute oncology teams during HSPCT placements; acute oncology wards rounds at the trainee’s local acute trust to include management of oncological emergencies and treatment toxicity; logging interactions with oncology teams through IPU, HSPCT and CSCPT/Outpatient settings; CPD including updates in oncology/palliative medicine registrar teaching.

You will continue to undertake on call duties at hospices.

The attachment could include (but not limited to) the following:

• Attendance at local oncology teaching sessions
• Attendance at new patient clinics and MDTs to include the common cancers – breast, lung, colorectal, prostate
• Inpatient wards rounds for both medical and clinical oncology
• Sessions spent with on call StR (during working hours) gaining experience of managing oncological emergencies and prioritising admissions
• Sessions spent with chemotherapy nurses
• Sessions looking at radiotherapy planning plus a visit to the mould room
• Attendance at Late Effects clinic
• TYA MDT meeting
• Meeting with members of Psychological services
• Experience of range of systemic anti-cancer therapies

Pain

Attachment will be based at Aintree University Hospital for Mersey Trainees, and either Salford Royal NHS Foundation Trust or Lancashire Teaching Hospitals for NW trainees. You will continue to undertake on call duties at hospices.

The attachment could include (but not limited to) the following:

• Attendance at local pain management teaching sessions
• Attendance at chronic pain management clinics and MDTs
• Inpatient acute pain wards rounds
• Attendance at interventional pain sessions
• Attendance at Walton Centre (observation of percutaneous cervical cordotomy)
• Sessions spent with pain nurses
• Meeting with members of the multi-professional team

Children & Young People and Transition (C&YP)

Attachment will be based at Claire House for Mersey Trainees, and Derian House NW trainees. You will continue to undertake on call duties at hospices.

 

The attachment could include (but not limited to) exposure to a children’s hospice and how differs from adult services.

• Care planning and integrated working with hospital/ social care and schools.
• Safeguarding issues and Child death panels awareness
• MDT meetings
• End of Life and car, ACP and parallel planning in this group.
• Symptom management and prescribing in C&YP
• Communication skills challenges with C&YP and parents/ families.
• Children’s bereavement services/ bereavement suite/ making memories
• Living well services/ various groups
• Mental Capacity assessments in C&YP
• Specific Learning disability awareness
• Collaborative working with oncology, neonatal and children’s community services
• Transition services including barriers to transition and so some experience of transition services (Claire House have a transition team trainees could spend time with)
• Collaborative working with Special schools and other voluntary organisations
• End-of life care in a children’s hospice

 

Internal Medicine

Internal Medicine placements will be hosted in other medical specialties in the region. On calls will be as part of the general medicine on call rota, at registrar level. Placements are usually for four months of the year.

Maintaining Capability

 

During ST4, when no substantive blocks of training in the acute unselected take will be done, PgDiTs are required to maintain capability in Internal Medicine by completing Maintaining Capability days, with an expectation for two or three weeks over the year. This should be organised by the trainee with the rota coordinator at their placement, and the TPD.

 

In the North West this has been at Salford Royal Hospital on the Emergency Assessment Unit. Good opportunities for assessments in this setting are:

• Ward round on medical high dependency unit.
• Day 2 reviews in A&E/EAU
• SDEC
• Clerking medial patients
• Working with the frailty team on EAU

 

In Cheshire and Merseyside, these have been linked to the local hospital for the Palliative Medicine service at which the PgDiT is training to support practical links and networks for patients in the area.

 

It is not expected for PgDiTs to meet their full ARCP requirements for IM within the maintaining capability days. However, completing assessments can be a helpful way to evidence these days within the portfolio.

 

PgDiTs can arrange maintaining capability days in a way that meet’s their particular training needs. However, it is not appropriate to use these days for mandatory training or courses, because they are intended for direct clinical care that maintains clinical ability. However, trainees remain entitled to the same education opportunities in terms of SDT and attending teaching as if they were on their normal placement.

Outpatient Clinic

The IM curriculum requires attendance at 20 outpatient clinics in specialties outside of palliative medicine over the four years of training. Same day emergency care/acute care unit shifts will not count towards this full number.

In ST4 it is recommended that you discuss an area of interest with your clinical and educational supervisor for these clinics which can be in areas related to Palliative Medicine. Ideally, developing a longitudinal relationship over the four years of training will help with detailing your progression and help with completion of Workplace Based Asssessments, QIPATs and teaching. The initial cohort of PgDiTs are doing clinics in movement disorders (e.g Progressive Supranuclear Palsy, Parkinson’s Disease), and Hepatology (managing people with advanced liver disease). Other areas may include Respiratory Medicine (interstitial lung disease, COPD), Cardiology (heart failure), Geriatric Medicine (frailty). The clinic should be in a specialty that is dual accrediting in Internal Medicine:

• Acute Internal Medicine,
• Cardiology,
• Clinical Pharmacology & Therapeutics,
• Endocrinology & Diabetes Mellitus,
• Gastroenterology,
• Genitourinary Medicine,
• Geriatric Medicine,
• Infectious Diseases (except when dual with Medical Microbiology or Virology),
• Neurology,
• Renal Medicine,
• Respiratory Medicine,
• Rheumatology and
• Tropical Medicine (except when dual with Medical Microbiology or Virology).

Clinics can be organised locally during IM placements, or if you have links from earlier years of training this can also be explored.

 

Curriculum

All Postgraduate Doctors in Training are required to complete the following curricula:

• Palliative Medicine Curriculum
• Internal Medicine Curriculum
• Generic Capabilities in Practice which covers all postgraduate curricula.

The bulk of information for this can be found on the ePortfolio, however you should also read and refer to the curricula which have additional explanatory details, on the JRCPTB website.

Plan your year based on the decision aids – these form the basis for ARCP review. A well organised personal library organised by training year and decision aid heading makes recording evidence much easier.

Palliative Medicine 2022 curriculum FINAL.pdf (jrcptb.org.uk)

Palliative Medicine ARCP Decision Aid (2022 curriculum) 2023 update.pdf (jrcptb.org.uk)

 

Supervision

Supervision is in line with the Enhancing Supervision model from Health Education England. PgDiTs will have an educational supervisor over the course of the training programme to provide continuity relating to the learning experience. Within clinical placements, you will have a named clinical supervisor in addition to the ES if they do not work there. For each clinical activity that you have, you should be clear about who is providing workplace support.

ePortfolio & Curriculum Engagement

Admission to higher specialty training requires a deeper level of self-direction in engagement with training to help you prepare for complete self-management as a consultant. ARCP panels assess progress through decision aids and this also includes and overall assessment of engagement.

Engagement means the level to which doctors have considered the curriculum requirements, their training needs and progress with these items.

A poorly engaged portfolio would have cursory or limited input and items completed at a rush prior to the ARCP.

 

Profile, including the Personal Library

Ensure that you update your posts. This is particularly important if you have had time out of programme and training less than full time, as your training year may change mid-way through a post.

The personal library should be organised per training year with subfolders to include evidence that is not available in other elements of the ePortfolio. For example:

1. ST4/5/6/7 (new folder for each training year)
   0. ARCP
      
      • Form R
      • CCT Calculator
      • CV
   0. Clinical Activity
      
      • Palliative Medicine Summary of Training
      • Internal Medicine Summary of Training
   0. Quality Improvement
      
      • Evidence of participation in clinical governance activities (including incidents, complaints and risk management), including audit or quality improvement. Project to be assessed with quality improvement project tool (QIPAT) – on form elsewhere on ePortfolios (see decision aid for requirements in each year)
   0. Teaching
      
      • Evidence of a range of teaching, including audience, topic and type of teaching; role in organising teaching; evidence of formal training in teaching and learning, feedback received (see decision aid for requirements in each year)
      • Summary of attendance at and involvement in teaching to be recorded in ePortfolio
   0. Clinical Management
      
      • Evidence can be collated in the ePortfolio through reflections, assessments and include: details of meetings attended (local, regional, national), including experience in chairing meetings; engagement in management, e.g. organising rotas, involvement in recruitment; evidence of working at a senior level (ST7); any formal management training (see decision aid for requirements in each year)
      • Trainees should complete two LEADER assessments by the end of training
   0. PYR (ST6 only)
      
      • A summary of what is required for completion of training to inform ARCP and to go into the separate form on the ePortfolio

Curriculum

Curriculum items should be rated each year, and you should write a short comment identifying your achievements and what you need for your next training year. If you have achieved Level 4, you should continue to self-rate and describe how you have maintained your capability.

Assessment

Please note the requirements for your training year and overall in the decision aids for the curricula.

Within Palliative Medicine training, there are two assessments that differ to Stage 1 Internal Medicine training. These are the Palliative Record of Reflective Practice and the LEADER assessment tool.

LEADER Assessment Tool

The LEADER tool was developed by HEE KSS as a method collect formative feedback to encourage development of leadership skills. It is based on the Medical Leadership Competency Framework (MLCF).

The tool can be used to highlight individual strengths and development areas through self-assessment and structured feedback from colleagues. LEADER is an acronym:

• Leadership in a team e.g. responsibilities and roles
• Effective services e.g. operational issues and guidelines
• Acting in a team e.g. contribution to meetings
• Direction setting e.g. exploring decision making skills
• Enabling improvement e.g. patient safety
• Reflection e.g. challenging preconceptions  

Example scenarios may include chairing of MDTs, organisation of junior doctor inductions, recognising limits, managing a team through a difficult scenario – please note this is not an exhaustive list.

Not all domains require completion at each assessment however a minimum of two are recommended alongside a concluding reflection. It is recommended that the PgDiT reviews the form prior to completion with their assessor.

A video e-learning module about the LEADER tool in practice (in Foundation training) is available in section 6 of the training resources on the Educator Hub: https://educatorhub.e-lfh.org.uk/Catalogue/Index  

Reflection

Palliative Record of Reflective Practice

Further information about this assessment is available at the Palliative Medicine website under “Forms and Guidance”https://www.thefederation.uk/training/specialties/palliative-medicine. This is recorded under the reflection section of the ePortfolio.

As part of Good Medical Practice, doctors should also record reflections relating to their scope of practice. This is uploaded to the ePortfolio. The following is recommended for completion in a training year:

• Palliative Record of Reflective Practice mandatory two per training year – This is a record of an in depth reflection encounter on a significant clinical or non-clinical issue conducted with a supervisor or other colleague such as chaplain, social worker, manager or nurse.
• Attendance at organised teaching log after each attendance (still need to do this as a consultant)
• Audit optional if details are submitted in personal library of protocols, results and outputs
• Generic Reflection Form optional depending on your preference for form structures/anything not covered in the other pre-populated forms
• Reflection on Clinical Event log four to six per training year
• Reflection on Learning during an Attachment optional
• Reflection on Learning Event optional
• Reflection on Management and Leadership Experience at least one a year helpful to log learning from events as there are requirements for this in each year's decision aid

Appraisal

Please complete summary induction and end point meetings as a minimum with your clinical supervisor. For longer posts, a mid-point appraisal may be helpful. You can also complete an educational meeting record for other meetings with supervisors. Your PDP should be updated at each post. Please consider your personal development and growth needs in this as well as curriculum attainment.

e-Learning

You may wish to link your e-Learning for Healthcare (https://portal.e-lfh.org.uk/) account to record additional CPD that you have done on this site.

Progression

Please note the requirements for Multi-consultant reports for your training year and level of Palliative Medicine and Internal Medicine work. Associate Specialists and other senior responsible clinicians with GMC supervisor accreditation can complete the MCRs.

Your ES report prior to the ARCP should be completed at least two weeks before the date of the ARCP to allow the panel to review it. In practice, this means meeting with your ES at least four weeks before the ARCP. It is important to review your evidence well in advance of your ES meeting as the report takes a significant amount of time to complete. Please ensure that your ES includes all your posts for your training year in the report.

You will need an educational supervisor report at the end of each training year, regardless of whether an ARCP is due. The exception to this is if your training year completes around the time of the ARCP season (May to the end of July). If you are unsure, please clarify this with your ES and TPD.

PYA/PYR

This stands for penultimate year report. This is completed 12 to 18 months before the end of your training. This forms the basis of review into your final year. It is also the last point to demonstrate if you have made exceptional progress and that an acceleration of CCT needs to be discussed at your penultimate ARCP. This review should be conducted with your ES and TPD.

Annual Review of Competency Progression

Most annual reviews of competency progression (ARCP) occur in May to June of every year with additional ARCPs for non-standard outcomes (2 to 5), three months prior to the completion of training or on an individual basis based on trainee need. Separate ARCP outcomes are issued for Palliative Medicine and IM. When in a training year that does not include a IM block the assessors will be looking at engagement with the IM curriculum but not necessarily the numbers of assessments etc.  Potential outcomes are as below:

• Outcome 1: Achieving progress and the development of competences at the expected rate
• Outcome 2: Development of specific competences required – additional training time not required
• Outcome 3: Inadequate progress by the trainee – additional training time required
• Outcome 4: Released from training programme with or without specified competences
• Outcome 5: Incomplete evidence presented – additional training time may be required
• Outcome 6: Gained all the required competencies for completion of training
• Outcome 8: Out of programme (for those currently undertaking research or experience)

The ARCP also acts as a stage post for your revalidation with the GMC. The Form R is an official document consisting of two parts, A & B, which is used to formally register doctors in training with the Postgraduate Dean. All PgDiTs are required to fill out a Form R when starting a new training programme. Return of the Form R to the deanery initiates the ARCP process and triggers the release of a National Training Number, which is used to identify you as a trainee in an approved training programme within the NHS.  You then need to submit an updated Form R at each ARCP. The Form R is submitted through Trainee Information System (TIS). Further details about the ARCP is available in the Gold Guide – Postgraduate Training Manual.

Prior to your ARCP, ensure that you have completed the following:

1. Form R (part A and B): This is found in TIS self- service.
   1. Make sure you download the completed Part A and B forms, save as PDFs and upload into your ePorfolio personal library.
2. Ensure that you have updated your ePortfolio the requirements for your training year based on the Palliative Medicine and Internal Medicine Decision Aids:
   1. Self-rate all the CiPs and Practical procedures - generic, IM and specialty: Write a comment by each CiP identifying the evidence to support this rating.
   2. Ensure that your ES has rated and commented on all generic CiPs, IM an PM clinical CiPs, and IM and PM practical procedures.
   3. Ensure that you have reviewed your Personal Development Plans (PDPs) and stated if they are achieved or not
   4. For IM Complete the Summary of Clinical Activity and Teaching Attendance (HST) under the Assessment tab: Note, once you have submitted this as non-draft, it cannot be edited again. This proforma splits out your teaching in a different way from the logbook requirements below, so make sure you record which teaching is internal/external/e-learning as you go along as well.
   5. IM and Palliative Medicine logbooks
      1. Palliative Medicine
      2. Internal Medicine https://www.thefederation.uk/sites/default/files/IMT%20acute%20take%20calculator%20and%20log%20of%20clinics%20and%20procedures%2021122019.xlsx

ARCP summary checklists are as follows for each training year: please check currency of this with published decision aids on The Federation website.

Master ST4 - 2022 Curriculum pre-ARCP Checklist

Master ST5 - 2022 Curriculum pre-ARCP Checklist

Master ST6 - 2022 Curriculum pre-ARCP Checklist

Master ST7 - 2022 Curriculum pre-ARCP Checklist

 

Specialty Curriculum Examination

Since 2011 there has been a mandatory Specialty Certificate Examination which must be passed prior to obtaining a CCT.  This is held every nine months and Postgraduate Doctors in Training need to pass this to achieve their certificate of completion of training.  There are no entry requirements for the SCE in Palliative Medicine, although trainees in UK training posts would normally take the SCE in their penultimate year of higher specialty training. Trainees who hold MRCP(UK), have gained the Certificate in Palliative Medicine and who are recommended for a CCT will be entitled to apply for the postnominal MRCP(UK) (Palliative Medicine).

Regional Teaching Programme: Palliative Medicine

The teaching programme runs from February – December with a 4-year ‘rolling’ programme of topics relevant to the Palliative Medicine curriculum, particularly directed at those areas not easily covered in routine clinical placements. The sessions are on Thursday afternoons, once a month, organised jointly by Postgraduate Doctors in Training, and consultant / senior SAS leads from North West and Mersey training programmes. The programme alternates between face to face sessions at St Rocco’s hospice, Warrington, and virtual sessions on Microsoft Teams.

Further guidance on the regional teaching programme is included as a separate document in your induction folder.

The teaching programme will include an annual ‘Away Day’ in June. The Away Day is an opportunity to focus on more innovative and topical subjects, and to promote networking and sharing of service innovation between palliative medicine Postgraduate Doctors in Training, consultants and SAS doctors across North West and Mersey training programmes.

Journal Club (North West only)

A PGDiT led journal club is held once a month on Microsoft Teams. Trainees will be given a date by the journal club lead to present at this.

Regional Teaching Programme: Internal Medicine

Internal Medicine teaching is organised by the deanery. Sessions are monthly on zoom. Dates are set in advance, and are included in the induction folder for 2024-25 and 2025-26. Sessions are recorded, and can be viewed up to one month after the date of the session. However, in order to receive a certificate of attendance, feedback must be received within two weeks of the session.

75 hours of IM study must be completed over the training programme, with 20 hours in the final year of training.

Simulation

The GIM curriculum requires 12 hours of simulation training over the four years of IMS2 training, including at least 4 hours in the final year of training. Sessions are organised throughout the year at different training sites, and an email to book onto one of these will be sent out by Nicola Moffitt from the deanery.

Study Leave

Postgraduate Doctors in Training have an allowance of 30 days of study leave per year, pro-rata based on full time training. For example, a Postgraduate Doctor in Training working LTFT at 60% would have an allowance of 18 days per year. https://www.nwpgmd.nhs.uk/study-leave

Regional teaching takes a proportion of this leave – currently 6 days a year.

Study funding is not available in periods of grace or when out of programme, except where that is for training (OOPT).

Study leave is not generally available for overseas events, however one international/meeting, providing all other curriculum requirements are met, will be considered for each doctor in training for any one programme, which can be defined as Foundation, Core, Higher or otherwise every three years.

For up-to-date information on Study Leave, including access to:

• The application website
• Reclaiming expenses
• The current policy and frequently asked questions

visit the deanery website https://www.nwpgmd.nhs.uk/study-leave

A list of recommended courses has been sent in your induction folder.

Higher Degrees

The deanery currently intermittently funds Masters level modules in education and leadership and management at Edge Hill University. If desired, this can be built on to PgCert level of a full Masters with self funded other degrees at Edge Hill, including an MSc in Integrated Palliative and End of Life Care. Details are available at https://www.edgehill.ac.uk/course/integrated-palliative-and-end-of-life-care-msc/.

Employment

Throughout your training you will be employed by the Lead Employer, currently St Helens and Knowsley Teaching Hospitals NHS Trust.

The following organisations have these responsibilities:

• Lead Employer – Overall employment responsibility including e.g. contracts of employment, employment checks, pay, restrictions/exclusions to clinical practice due to health needs and disciplinary matters. https://leademployer.merseywestlancs.nhs.uk/
• Host Organisation – Provides day to day management, and day to day supervision of training by clinical & educational supervisors
• NHS England – Responsible Officer, supervision of training & progress in training. HEE ensures consistency with the handling and resolution of concerns raised relating to capability and health matters. https://www.nwpgmd.nhs.uk/

You should contact the Lead Employer if you have any problems with pay or health.

You should contact your educational or clinical supervisor about issues relating to your day to day work programmes, on call and access to opportunities.

You should contact your training programme director if there are issues with training and achieving curriculum coverage that haven’t been able to be resolved locally. You should also contact your TPD if you are considering taking time out of programme, working less than full time or leaving the programme prior to completion of training.

Less Than Full Time Training

All Postgraduate Doctors in Training can apply for less than full-time training depending on the categories below. A

Eligibility Categories

All PGDiTs will be able to apply for LTFT subject to completing local processes. All PGDiTs who wish to commence LTFT training will need to identify one of seven different opportunities they wish to apply for in accordance National LTFT guidance.

These options are as follows, and are included in the Application to Commencement LTFT Training Form:

• Disability/ill Health
• Caring Responsibilities
• Welfare and Wellbeing
• Unique Responsibilities
• Religious Responsibilities
• Non-Medical Development
• Career Development

For welfare and wellbeing (work/life balance) this can only be applied for during one of two application windows annually, for all other opportunities a minimum of 16 weeks notice must be provided where practically possible.

The form will ask for the reason as it does now and in the case of ill health ask for confirmation of engagement with health care /OH (duty of care) – this will allow us to monitor the situation.

All applications will need to be completed with at least 16 weeks’ notice as per National guidance. This is so we can adhere to the 12 weeks code of practice to allow Trusts notice to complete the required work schedules.

Although you will not need to re-apply for LTFT at the start of each rotation (unless you wish to change percentage or return full time) you will need to liaise with each host placement regarding your work schedule prior to each placement.

To simplify the process below are points to note:

1. LTFT will commence only at rotation points – unless an unexpected reason is identified during a placement for example health, carer, parental leave, this includes changes in any percentage in LTFT training.
2. Increasing back to fulltime will only be allowed at a rotation change and with notice unless exceptional circumstances apply.

You can access the Application to Commence LTFT Training form here. When completed please send the form to england.ltft.nw@nhs.net under the subject heading "Eligibility Request". Failure to do this may result in a delay in your eligibility being confirmed.

Once eligibility is confirmed, PGDiTs will be sent the Less than Full-Time Training Approval Form and a Step-by-Step Guide to assist in its completion. Please note that for training approval, LTFT PGDiTs have to work a minimum of 50% (5 sessions) of the full-time equivalent although 60% is the norm.

For up-to-date information on LTFT training visit the NHS England North West website.

Time Out of Programme

Absences from the training programme to undertake time out of programme for clinical training (OOPT), research (OOPR), clinical experience (OOPE) or career breaks (OOPC) must be approved by the Postgraduate Dean or her deputy on the advice of the relevant Specialty School. Applicants are therefore advised to discuss their proposals as early as possible with their Training Programme Director.

All Postgraduate Doctors in Training must give at least six months’ notice of intention to take time out of programme and all Postgraduate Doctors in Training are therefore advised to think about taking time out of programme well in advance of the intended date and seek the advice of their Educational Supervisor and Training Programme Director so that it can be considered at Annual Review as part of learning objectives for the forthcoming year. This is particularly important if the time out of programme will count towards training and GMC approval is required.

Categories of OOP

OOP for Clinical Training (OOPT)

This allows the Postgraduate Doctor in Training to spend time in clinical training that has been prospectively approved by the GMC, and which is not part of the Postgraduate Doctor in Training's specialty training programme. This includes time 'acting-up' as a consultant. The duration of OOPT will normally be for a period of up to 12 months (‘acting up’ is limited to 3 months and can only take place in the final year of the programme).

OOP for Clinical Research (OOPR)

This allows the Postgraduate Doctor in Training to undertake research, normally for a higher registerable degree, e.g. PhD. Time spent out of programme for research purposes can be recognised towards the award of CCT when the relevant curriculum includes such research as an optional element. The duration of OOPR is normally up to a maximum of 3 years, with a 4 year maximum in exceptional circumstances which requires the prospective approval of the Postgraduate Dean.

OOP for Clinical Experience (OOPE)

This allows the Postgraduate Doctor in Training to gain clinical experience, which is not a requirement of the specialty training programme curriculum. This does not require prospective GMC approval and does not count towards CCT. This includes working overseas in developing countries. The duration of OOPE will normally be for a period of up to 12 months.

OOP for Career Break (OOPC)

This allows the Postgraduate Doctor in Training to take a planned career break to pursue other interests (e.g. domestic responsibilities, work in industry, developing talents in other areas and entrepreneurship). The duration of OOPC is normally for a period of up to 12 months, with a second year at the discretion of the Postgraduate Dean.

Out of Programme Pause (OOPP)

This allows Postgraduate Doctors in Training in specialty training to step off the training ladder and undertake work in the NHS or a similar patient-facing role in the UK. Experience and competences gained outside of training may be then considered on the Postgraduate Doctor in Training's return to their training programme.

For up-to-date information on going out of programme, visit the NHS England North West website.

Acting Up as a Consultant

Acting up allows Postgraduate doctors in training to gain experience of Consultancy whilst still maintaining the supervision afforded by their training programme. You must be within one year of your CCT date to act up as a Consultant (AUC). There is fixed maximum period of 3 months. LTFT postgraduate doctors in training may apply for a period of AUC on a pro rata basis.

Before commencing an AUC position, you must formally apply and request approval using the AUC form.

• Postgraduate doctors in training are responsible for arranging the completion of sections A-D and sending the completed form and supporting documentation to HEE.

• You are responsible for informing your current local education provider of your plans.

• Where you will be directly employed by a local education provider, you must also ensure the relevant gaining organisation complete section E of the form.

• Applications should normally be made a minimum of 16 weeks prior to the proposed start date of the acting up arrangement in order to meet code of practice requirements, however the notice period may be waived in exceptional circumstances.

Period of Grace

Doctors in training can apply to take up a period of grace when they are approaching their completion of training date. This is a period of 6 months where trainees will continue to be employed and work as part of the training programme while they find a consultant post. A notice period of 3 months is required when resigning from post.

 

 

 

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