General internal medicine should be compulsory

  • Date: 26 September 2013

DUAL training with general internal medicine should be mandatory for trainee doctors in all specialties in order to cope with future patient needs, according to a Royal College of Physicians report.

General internal medicine should be promoted as a “valuable and attractive career option, alongside acute and intensive care medicine”, with more training opportunities made available in the specialties, the report says.

These are some of the views set out by the Future Hospital Commission which was established by the RCP in March 2012 to consider how hospital services should adapt to meet future challenges in NHS secondary care. Their detailed report Future hospital: Caring for medical patients looks at a number of ways in which the provision of patient care should be changed.

The authors call for a new focus on acute and general medicine in hospital and community settings, explaining: “The competencies possessed by consultants in both specialties (together with those of intensive care medicine) render them fit to lead, manage and/or deliver care across the whole care pathway.

“Those with acute care competencies may be more suited to work within the acute medical unit, whilst those trained in (general) internal medicine may undertake the delivery of ward care.”

The report also highlights the importance of more integrated working of doctors with consultant surgeons on surgical wards. This could lead to fewer wards being designated as ‘surgical’, which would have “major implications for surgical trainees.”

It states: “Potentially all but the more senior trainees would be redeployed to physician-supervised duties and re-aligned to medical training, expanding the pool of trainees within a single training programme available to look after patients on almost all hospital wards.”

A total of 50 recommendations are contained in the report, covering areas such as the organisation and staffing of hospitals, managing the interface between primary and secondary care, the medical workforce, and the culture of the NHS.

The Commission visualises radically changing hospital structures, with a single unified medical division at the centre of delivery of hospital care and holding clinical, managerial and budgetary responsibilities.

Patients would be cared for by a named consultant responsible for coordinating their care, while hospitals would switch to a seven-day system of care.

Future Hospital Commission chair Michael Rawlins acknowledged the report had “major implications” for clinical practice and medical training, adding: “Its implementation will be a challenge for us all, but implement it we must. Our present and future patients will expect, indeed demand, no less.”


Future hospital: Caring for medical patients

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