Acute internal medicine (AIM) is an exciting, varied, and dynamic medical specialty, concerned with the assessment, diagnosis and management of adults presenting to secondary care with acute medical illness.
It also entails the management of busy acute medical units (AMUs) to ensure that they deliver high-quality, efficient and patient-centred care.
AIM trainee characteristics
Trainees in AIM need particularly:
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good team-player skills, including clinical leadership and change-management skills
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flexibility, adaptability and lateral thinking skills
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excellent communication skills, both spoken and written
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the ability to work (and enjoy working) under pressure.
Working in AIM
This is a hospital-based specialty, with the majority of the work involving care of medical patients around the time of admission to hospital. The spectrum of clinical problems encountered in the AMU is very wide, and this variability enables trainees to become experts in assessment, investigation, diagnosis and management across multiple disciplines.
Training
Training concentrates not only on recognition and management of acute medical emergencies, but also on the development of ambulatory care systems, and the acquisition of skills in leadership and management of AMU as a whole.
There is also a requirement to develop an additional specialist skill (usually in the form of either a professional qualification, a procedural skill, or a research degree. Common examples include diplomas in medical education or toxicology and practical skills such as bed side echo). There are also options to extend training and gain extra qualifications in stroke/critical care to CCT level.
Training includes time on AMU with a focus on managerial AMU experience towards the end of higher specialist training. There are also mandatory attachements in respiratory medicine, cardiology, acute elderly care and intensive care. Rotations may also include others such as gastroenterology/neurology/stroke but this varies from region to region.
Focus on medical problems and ongoing care
The specialty is distinct from emergency medicine (ED), because it focuses specifically on medical problems and includes more responsibility for ongoing care - although acute physicians do work in close collaboration with emergency medicine specialists. There is also a close relationship with critical care and most specialities will offer degrees of in-reach into the AMU.
Specialty structure
Acute internal medicine was formally recognised as a specialty in 2009, having previously been a subspecialty of general internal medicine.
It can be entered from core medical training or acute care common stem training; entry at ST3-level requires full membership of the royal college of physicians, MRCP(UK).
The indicative training time is 4 years for AIM or 5 years for AIM plus GIM dual speciality training. If stroke or critical care CCTs are aded the training will typically be 6 years or longer.
Medical Care
Find out more about acute internal medicine and the services delivered by the specialty on Medical Care – the RCP’s online guide to service design.
Further information
Round 1
Acute internal medicine is devolved into six clusters. Applications are assessed by the lead region to which they have been devolved, therefore please contact the lead region for any queries regarding this specialty.
| Acute internal medicine 2019 ST3 R1 - regional contact details by cluster | ||
|---|---|---|
| Clustered regions | Lead region | Contact details |
|
London and KSS |
n/a | |
|
East of England East Midlands West Midlands |
West Midlands | |
|
North East North West Yorkshire & Humber |
North East | |
|
South West Wessex Thames Valley |
Thames Valley | recruitment@thamesvalley.hee.nhs.uk |
|
Wales |
n/a | heiw.recruitment@wales.nhs.uk |
|
Scotland |
n/a | http://www.scotmt.scot.nhs.uk/contact-us/hospital-specialty-recruitment-contacts.aspx |
Eligibility
This specialty uses the standard ST3 eligibility criteria, and does not accept candidates from any alternative training routes.
Please visit the am I eligible? section of this website for further information.
Cascadable application model
This specialty uses the cascadable application model. If you apply to this specialty you will be required to give (up to) four preferences of regions on your application form, ranked in order of preference.
Once your application is confirmed as eligible, in shortlisting you will be allocated to a region for interview based on the score awarded to your application and subsequent ranking, your regional preferences and the interview capacity available at each region.
Your application will be allocated to your first-choice preference region if possible; if the region has reached capacity with higher-scoring applicants, it will instead be cascaded to your second-choice; if that is also full, it will then be cascaded to your third-choice; and so on.
Most applicants are allocated to their first choice and normally either none or only a few cascaded to a lower preference. In a small number of cases, usually where an applicant only preferences one or two regions, an applicant will not be shortlisted. Information on the outcome of shortlisting from previous years is available in the document library.
Regional clusters
It is normal for regions to join together for recruitment purposes, forming amalgamated regional ‘clusters’. A candidate applying to any such cluster can consider posts available across all constituent regions within the cluster. Details of the regional clusters can be found on the 'Who do I Contact?' tab.
Clearing
As the main round draws to a close this specialty can implement a period of national clearing, should any vacancies remain. Further information can be found in the clearing section.
Round 2
If participating in round 2, this specialty will use the single centre recruitment model, whereby the specialty will nominate a particular region to act as lead for the round and host all interviews with applications made nationally; the lead region will be confirmed in the lead up to the start of the round.
Flexible portfolio training
New for 2019, this specialty will be participating in the ‘flexible portfolio training’ scheme. This protects one day a week (or 20% time equivalent across the year) for the trainee to engage in project work that will aid their professional development in one of four pathways; medical education, clinical informatics, quality improvement or research. This is an opportunity to acquire and develop key skills and engage in meaningful project work, in a different environment, alongside time in training that will be the springboard to a consultant career.
Further details about the scheme, and the regions where this is available can be found by visiting the website https://www.rcplondon.ac.uk/projects/flexible-portfolio-training or by emailing flexibleportfoliotraining@rcplondon.ac.uk
It is possible that there could be changes between now and the interview period. Please bear this in mind when reviewing the information below, although in most cases it is not expected this will change, or any changes will be minimal. You are advised to check back in closer to the time of interview. The date at the foot of this page shows when the page was last reviewed.
Interview content
You will spend approximately 20 minutes at station 1 and 10 minutes at station 2 and 3, with three-to-five minutes' transfer time between each. Thus the overall time for the interview will be approximately 55 minutes.
Click on the relevant stations below for more information on the content of the interview.
Please note that this is subject to change, and will be confirmed by the date of interview.
This is where your application form and training to date will be reviewed. This will include checking the documentation you have brought along to ensure all content on your application form is correct.
The first half of the time will be spent with the interviewers going through your evidence folder, checking that the evidence supports the claim made on your application form and asking you to explain or clarify the achievement.
Following the evidence check the interviewers will ask you questions covering two scoring areas:
- Your achievements and engagement with training and learning.
- Your suitability for and commitment to training in the specialty.
Prior to arriving at station 2 you will be given a clinical scenario to review. Upon arrival at the station you will be asked questions relating to this scenario.
The clinical scenario will be relatively brief (two/three sentences), so once you have read this, the remainder of the pre-station time will allow you to undertake some short preparation (just mental preparation - this does not mean making notes, etc.)
Scenario considerations
The scenario will describe a hypothetical clinical situation which has arisen in which you are, or have become, involved. Some points to consider when reviewing the scenario and preparing for discussion are:
- what steps you would take
- any potential treatments possible
- any further information you would gather
- how you would go about communicating with any people (eg patients, family members, colleagues) involved in the scenario.
You should also take into account any other factors you deem appropriate, using your experience and professional judgement.
Areas for assessment
One mark will be awarded to you based on your suggestions and responses to the clinical scenario. The second mark will be on the communication skills you display.
This will be both an assessment of how you would communicate with patients, colleagues, etc. in the scenario, as well as of how well you communicate with interviewers at the station.
This station will feature assessment of an ethical scenario, and discussion of a question on the subject of professionalism & governance.
Ethical scenario
As with the clinical scenario at station 2, this takes the form of a hypothetical situation, described briefly in text form, details of which will be given to you before arriving at the station.
This scenario focuses less on a clinical situation, and deals more with consideration of the moral, ethical, legal (etc.) issues which may arise in a particular situation.
The first area of assessment here will be your suggested reponses to the ethical scenario during discussion, as well as your knowledge of the different considerations required.
Professionalism & governance
Following the ethical scenario will be discussion of professionalism & governance.
This discussion will be prompted by a short question (often a single sentence) provided by interviewers. This will be given verbally by interviewers once ethical scenario discussion is finished.
This section of the interview is designed to assess your demonstration and understanding of professionalism and governance in a given situation.
Familiarise yourself with Good Medical Practice
Please note - assessment at station 3 is underpinned by the principles of GMC Good Medical Practice.
Interview scoring
Appointable - automatic
If you are awarded a score of at least 3/5, for all marks given to you at your interview, then you will automatically be classed as appointable.
Not appointable - automatic
If any of the 12 scores awarded to you at interview are 1/5, this will reflect poor performance and an area of major concern.
If four or more of your 12 interview scores are of 2/5, this will reflect several areas of concern across your whole interview.
Should your interview assessment fall under either category above, the level of concern over your potential progression to ST3 will see your application classed automatically as not appointable.
Appointability subject to panel decision
In the event that your 12 interview scores contain one, two or three marks of 2/5 (and the rest 3/5 or above), your appointability status will be subject to discussion in the post-interview 'wash-up' meeting.
The clinicians who have interviewed you will discuss your general performance during the interview and any concerns or otherwise they have about your application as a whole.
Should they deem it appropriate, your application will be classed as appointable, and you can then be considered for post offers; whereas if they feel their concerns are too substantial for this outcome, they must class your application as not appointable, and it will progress no further in the current recruitment round.
Review vs automatic status
Please note there is no distinction made between candidates judged as appointable automatically, and those classed as appointable on review. Once deemed appointable it is only your overall score which will be used to determine ranking.
Total score calculation
After interview, a weighting is applied to the scores in each area, as well as the application form score, to give a 'total score'. This score determines your ranking which is used to inform how offers are made. The weighting of different sections, as well as the method by which your total score is established, can be seen by clicking on 'Total score calculation' below.
Please note that this is subject to change, and will be confirmed by the date of interview.
| Int. 1 | Int. 2 | Weighting | Max score | |
| Station 1 | ||||
| Evidence | / 5 | / 5 | x1.6 | / 16 |
| Suitability for specialty | / 5 | / 5 | x1.2 | / 12 |
| Station 2 | ||||
| Clinical scenario | / 5 | / 5 | x1.6 | / 16 |
| Communication mark | / 5 | / 5 | x0.8 | / 8 |
| Station 3 | ||||
| Ethical scenario | / 5 | / 5 | x1.6 | / 16 |
| Professionalism and governance | / 5 | / 5 | x1.2 | / 12 |
| Raw interview score | / 60 | |||
| Interview score (including weighting) | / 80 | |||
| Short-listing (app form) | / 80 | x0.25 | / 20 | |
| Overall assessment score | / 100 | |||
As part of the process of applying to ST3, you may wish to gain an idea of how recruitment progressed in previous years for the various specialties participating in the nationally-coordinated recruitment.
To this end, we have published data dating back to 2013 (where this is available), based around four main areas:
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Competition ratios - application numbers submitted to each specialty, along with the number of NTN and LAT posts available in each. It is worth noting that posts are subject to change throughout the round (increasing on average between 20-40%), and post numbers for this data are taken at the end of the round.
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Shortlist scores - the scores awarded to all submitted applications, including average scores and distribution nationally.
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Total scores - the total score awarded to all candidates who completed the full recruitment process for a specialty (application and interview), including some analysis of scores.
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Post fill rates - the number of posts filled by region.
We have published information for all specialties participating in our process that year; consequently not all specialties will have data in all cases.
Round 1
| Year | Apps. | NTN posts | LAT posts | Total posts | Comp. | Unique* |
|---|---|---|---|---|---|---|
| 2018 | 244 | 129 | 1 | 130 | 1.9 | 29% |
| 2017 | 237 | 125 | 0 | 125 | 1.9 | 24% |
| 2016 | 230 | 117 | 2 | 118 | 2.2 | 23% |
| 2015 | 203 | 95 | 21 | 116 | 1.8 | 22% |
* the percentage of unique candidates that only applied to this specialty (out of the 24 PSRO-coordinated specialties)
Round 2
| Year | Apps. | NTN posts | LAT posts | Total posts | Comp. |
|---|---|---|---|---|---|
| 2018 | 115 | 62 | 0 | 62 | 1.9 |
| 2017 | 95 | 68 | 0 | 68 | 1.4 |
| 2016 | 71 | 48 | 1 | 49 | 1.4 |
| 2015 | 61 | 48 | 24 | 72 | 0.8 |
Provisional post numbers
Specialty vacancy numbers are available in the table below, broken down by region and divided between substantive national training number (NTN) and locum appointment for training (LAT) posts.
It is the intention that initial post numbers for all regions will be published prior to the application opening date, although this cannot be guaranteed. Numbers will be updated as and when notifications are received from each region and will be checked later in the round when programme preferences are open for selection.
Numbers subject to change
Please be aware that it is not uncommon for vacancy numbers to change throughout the round.
More commonly, post vacancy numbers can increase as the round goes on (and confirmation of posts becomes available); but it is also possible that numbers can reduce as well. On average post numbers rise between 20-40% from the start to the finish of the round but this can vary greatly for individual specialty/region combinations.
It is possible that regions which do not have a post at the start of the round may declare one after applications have closed. Whilst we try and minimise instances of this, it is not always possible to predict vacancies so even if there appears not to be a vacancy in your preferred specialty/region combination, you may wish to consider applying in case one becomes available during the round; you can check with the region concerned if you wish to check on the likelihood of a post arising.
Generally, once a region enter a post into a round they would always have at least one post available and would only withdraw it in exceptional circumstances.
Round 1 interview dates and posts
| Region | NTN posts | LAT posts* | Interview date(s) |
|---|---|---|---|
| HE London and South East |
(London) 1-7 |
n/a |
3 April 2019 |
|
(Kent, Surrey, Sussex) 0-3 |
n/a | ||
| HE West Midlands (lead) ‡ | 4-6 | n/a |
2 April 2019 |
| HE East of England † | 7-10 | n/a | |
| HE East Midlands † | 9 | n/a | |
| HE North East (lead) † | 7 | n/a |
20 March 2019 |
| HE North West † |
(Mersey) 4 |
n/a | |
|
(North Western) 3 |
n/a | ||
| HE Yorkshire & Humber † |
TBC |
n/a | |
| HE South West † |
(Peninsula) 4 |
n/a | 5 April 2019 |
|
(Severn) 0-4 |
n/a | ||
| HE Wessex † | 2-6 | n/a | |
| HE Thames Valley (lead) | 3-5 | n/a | |
| Wales | 1 | TBC | 8 April 2019 |
| Scotland** | 14 | TBC |
29 March 2019 |
*English LATs
Please note, English regions do not recruit to LAT posts.
**Scotland post numbers
If you are interested in working in Scotland, a breakdown of post numbers by the four Scottish deaneries is available on the Scottish Medical Training website . This has details of all specialty training post numbers in Scotland, including specialties which are not part of the nationally-coordinated process.
Please note that whilst we endeavour to keep the Physician ST3 recruitment website up to date, the SMT website will always be the more accurate one where they differ.
† Regions taking part in flexible portfolio training
Trainees will be able to preference posts with or without the 'flexible portfolio training' option where available. For further information on acute internal medicine, and the distribution of regions to each pathway, please visit https://www.rcplondon.ac.uk/projects/flexible-portfolio-training