The 2015 curriculum changes delivered many Shape of Training priorities – increasing generic capabilities, increasing flexibility of training and shared training opportunities between different specialties. As a consequence, neither RCPath nor the JRCPTB believe major changes are required in the structure and content of training in the Infection specialties. The assessment framework is being revised in line with the GMC’s requirement to develop outcomes based training.

The changes in the Physician’s training model from 2 years core medical training and 5 years specialty training to 3 years basic Internal Medicine (IM) and 4 years specialty training will impact on the 2015 Infection training model.

Group 1 specialties are the main specialties supporting acute hospital care and the majority of training opportunities are in these specialties. IMT will comprise the first three years post-foundation training followed by competitive entry into a group 1 specialty plus internal medicine. Group 2 specialties will continue to deliver non-acute, primarily outpatient-based services and will not dual train in internal medicine; IMT will therefore comprise the first two years post-foundation training.

Trainees in Infectious Diseases (ID) without Medical Microbiology (MM) or Medical Virology (MV) will be on the group 1 pathway, thereby also obtaining a CCT in Internal Medicine. Trainees on this programme will be moving to the 3 + 4 year model, reducing the content of specialty training to incorporate enhanced generic acute medical care capabilities.

Trainees in ID with MM or MV, as well as those training solely in MM or MV, will be on the group 2 pathway, retaining the 2 + 5 year training model with recruitment to the specialty after 2 years basic IM plus MRCP. This decision has been made in view of the following:

1. The depth and breadth of the pathology curricula (MM and MV), including the need to learn core laboratory skills. The 2014 curriculum reduced the length of higher specialist training for ID/MM and ID/MV from six to five years and a further reduction would not be possible. 
2. Those with CCTs in ID/MM and ID/MV will not be expected to participate in acute internal medical services at consultant level. This is necessary due to the requirement to integrate essential Pathology/laboratory components of training from the early stages of specialty training, and the impossibility of delivering the programme if 1.5 years were lost to acute internal medicine, thereby developing capabilities that would not be relevant to future consultant practice or job planning.

The Infection specialty curricula comprises six generic and seven specialty-specific Capabilities in Practice (CiPs), linked to the nine domains of the Generic Professional Capabilities Framework:

1.    Able to function successfully within NHS organisational and management systems.
2.    Able to deal with ethical and legal issues related to clinical practice.
3.    Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement.
4.    Is focussed on patient safety and delivers effective quality improvement in patient care.
5.    Carrying out research and managing data appropriately.
6.    Acting as a teacher and clinical supervisor
7.    Able to provide clinical leadership and support to the laboratory.
8.    Able to use the laboratory service effectively in the investigation, diagnosis and management of infection.
9.    Able to advise on infection prevention, control and immunisation.
10.    Able to manage and advise on important clinical syndromes where infection is in the differential diagnosis.
11.    Able to lead and advise on treatment with and stewardship of antimicrobials.
12.    Providing continuity of care to inpatients and outpatients with suspected or proven infection.
13.    Managing end of life care and applying palliative care skills (for ID/MM and ID/MV trainees only)

 

There will be differing levels of entrustment for each of the specialty specific CiPs depending on the Infection training programme being followed by the trainee. Entrustment levels are behaviourally anchored ordinal scales based on progression to competence and reflect a judgment that has clinical meaning for assessors:

Level descriptors for specialty CiPs:

Level	Descriptor
Level 1	Entrusted to observe only – no provision of clinical care
Level 2	Entrusted to act with direct supervision: The trainee may provide clinical care, but the supervising physician is physically within the hospital or other site of patient care and is immediately available if required to provide direct bedside supervision
Level 3	Entrusted to act with indirect supervision: The trainee may provide clinical care when the supervising physician is not physically present within the hospital or other site of patient care, but is available by means of telephone and/or electronic media to provide advice, and can attend at the bedside if required to provide direct supervision
Level 4	Entrusted to act unsupervised

 

 

The below diagrams describe the proposed pathways for Infection specialty training programmes:

Infectious Diseases (with Internal Medicine stage 2):

 

Dual training in Infectious Diseases/Medical Microbiology, Infectious Diseases/Medical Virology:

 

Medical Microbiology:

 

Medical Virology:

 

Tropical Medicine (with Internal Medicine Stage 2):

 

Dual training in Tropical Medicine/Medical Microbiology, Tropical Medicine/Medical Virology: