Shape of Training: Delivering Palliative Medicine Training During Internal Medicine
Archive Information

May 2018 Update for APM Members re Shape of Training

November 2017 Update for APM Members re Shape of Training

We are keen to keep members up to date with news or developments related to Shape of Training and how it is going to affect our specialty. There will now be a monthly update posted on the APM website with contact details if you have any queries or comments.

With the recent approval by Ministers in the summer Ministerial Statement it now seems very likely that Shape of Training will happen at some point. This means that at the end of training doctors will dual accredit in Palliative Medicine and Internal Medicine. During their four year specialty training they will be required to complete 12 months of training in Internal Medicine and participate in the acute take. Specialty Training Model Group 1 November 2017

Exact timescales for implementation remain uncertain and it is important for everyone to remember that things can and do change.

Key Messages

  1. Palliative and end of life care is now part of the new core curriculum for Internal Medicine which is a very positive step. The earliest entries to the new internal medicine training will be August 2019. How the training and experience will be delivered remains under discussion. The curriculum has been submitted to the GMC for approval and we are now awaiting the outcome. Work has started on the new curriculum for Palliative Medicine.
  2. The first intake for dual accredited Palliative Medicine trainees will be August 2022. These trainees will be required to continue develop their internal medicine competence during specialty training, which will include participation in the acute take. It is therefore crucial that we make sure that there are adequate backfill arrangements to cover the specialty on call. JRCPTB are very aware of our concerns and are actively exploring with Lead Deans and Heads of School how we can best be supported. We hope to have more news in the next few months and will ensure we continue our regular dialogue with the Royal Colleges and JRCPTB
  3. We have been reassured that implementation of Shape should not result in any region losing specialty training places. If you hear otherwise please contact your local Training Programme Director immediately
  4. Shape of Training will present our specialty with both opportunities and challenges. We need to make sure we can promote the positive aspects and mitigate any risks. The Association for Palliative Medicine and the Specialty Advisory Committee have formed a joint Working Group, to coordinate the specialty response over the next 18-24 months which includes Hospice UK and patient representatives.
  5. There will be an hour long interactive session on Shape at the APM conference in Bournemouth in March 2018.

Any queries or comments please contact Dr Alison Coackley, Chair of the APM/SAC Shape Working Group Email: Alison Coackley

A New Direction for Palliative Medicine


As many members will be aware the Shape of Training review has been under way for some time. It now appears likely that Shape will happen. It will create an entirely new landscape for training and for how trainees and future consultants in palliative medicine work.

We must ensure that training equips doctors for the job they will be doing. We must also maintain the relevance and the ethos of our specialty in the new world. Hard work over the past twenty years to ensure palliative medicine is recognised as being essential across all care sectors must not be wasted. We now have 550 consultants across the UK, a robust training programme and an ability to effectively influence national policy agendas.

Proposed JRCPTB Framework for New Training Model

In the summer of 2015 we circulated a briefing paper about Shape and the potential impact on palliative medicine. At the same time the APM conducted a survey of members which highlighted concerns about aspects of Shape including our future role in acute take. The survey formed the basis for discussions with JRCPTB who then produced a framework describing how the 29 medical specialties would operate within the new model of training.

This new framework left us sitting apart from all of the key and relevant medical specialties. It was clear that we were in real danger of losing our ability to directly influence patient care. This position generated real concern for many, including training leads and those representing our specialty.

Options Appraisal

An options appraisal was generated to facilitate further discussion. The two options are summarised in Figure 1 (on page 2). There was widespread constructive debate within the APM, the JSC the SAC and with trainees, supervisors and consultants across the UK. Notwithstanding the concerns, the consensus was that the specialty needed to change position and to support Option 1 in order to avoid being marginalised. This has also been the conclusion reached by many of the other medical specialties such as medical oncology. This relates to training and it does not mean that future consultants would be expected to routinely be part of acute medical takes in hospitals. We do need to be able to assess an acutely unwell patient in any care setting to reach the best management plan; in this way we play a part in the acute care pathway but in the context of our services.

Figure 1 Summary of Options Appraisal

  Option 1 Option 2
Input to acute medical care Yes.  May include direct contribution to acute take No contribution to acute take
CMT training Three years using new Internal medicine  curriculum Two years.  Curriculum unclear
Specialty training  Four years. 12 months would focus on Internal medicine Four years.  Only focused on Palliative Medicine
Dual accreditation Yes Unlikely
Future Consultant role  Negotiated according to local need e.g. level of input to acute take.More flexibility in career development No option for negotiation. Potentially few employment options in acute Trusts. Focus on community and hospice settings.  Less flexibility
Selection criteria May make MRCP the desirable entry pathway  Could remain  broad  to include MRCGP etc
Potential to change specialty during training Yes Unlikely
Position of other medical specialties Respiratory, cardiology, geriatrics, medical oncology Audio vestibular medicine, ophthalmology, genetics

Way Forward

The RCP and JRCPTB understand our reservations but have welcomed our decision to join with other key specialties in focusing on the development of a new internal medicine curriculum to link with a new curriculum for specialty training. Both of the new curricula will be concise with a focus on defining what a competent physician can do. There will be approximately 10-14 Competencies in Practice for each curriculum with key descriptors for each competency. How we assess competency is being reviewed with a real determination to move away from box ticking and multiple assessments.

Embedding a competency in palliative and end of life care in the new internal medicine curriculum will help to ensure that all future physicians, whatever their specialty, have appropriate training, experience and competence in looking after patients at the end of life. The new curricula will require pilots. These could start as early as 2017 with 2019/2020 suggested as the target for rolling out the new model of training.

We know that there will be further changes and some uncertainty remains. The APM, JSC and SAC will work together to ensure that palliative medicine is represented, influential, protected and developed. We will continue to provide members with regular updates via this newsletter and the APM website. Training Programme Directors will remain a key contact point in each locality

There are real opportunities and exciting times ahead. We are confident that as a specialty we are now in a better position to influence both patient care and the training of doctors in all medical specialties.

Dr Alison Coackley
Chair of Palliative Medicine Specialty Advisory Committee

Dr Stephanie Gomm
APM Executive Members and Chair of Workforce Committee

Dr Idris Baker
Member of Palliative Medicine Specialty Advisory Committee

Dr Wendy Makin
Chair of the Joint Specialty Committee for Palliative Medicine

2015 SoT member survey results

To review the 2015 member survey responses regarding SoT please click here