Acute Internal Medicine (AIM) with General Internal Medicine (GIM) CESR Portfolio Guide

• Aware of, and adheres to, the GMC professional requirements
• Aware of public health issues including population health, social determinants of health and global health perspectives
• Demonstrates effective clinical leadership
• Demonstrates promotion of an open and transparent culture
• Keeps up to date through learning and teaching
• Demonstrates engagement in career planning
• Demonstrates capabilities in dealing with complexity and uncertainty
• Aware of the role and processes for commissioning
• Aware of the need to use resources wisely

• Aware of national legislation and legal responsibilities, including safeguarding vulnerable groups
• Behaves in accordance with ethical and legal requirements
• Demonstrates ability to offer apology or explanation when appropriate
• Demonstrate ability to lead the clinical team in ensuring that ethical and legal factors are considered openly and consistently

• Communicates clearly with patients and carers in a variety of settings
• Communicates effectively with clinical and other professional colleagues
• Identifies and manages barriers to communication (e.g. cognitive impairment, speech and hearing problems, capacity issues)
• Demonstrates effective consultation skills including effective verbal and non-verbal interpersonal skills
• Shares decision making by informing the patient, prioritising the patient’s goals and wishes, and respecting the patient’s beliefs, concerns and expectations
• Shares decision making with children and young people
• Applies management and team working skills appropriately, including influencing, negotiating, re-assessing priorities and effectively managing complex, dynamic situations

• Makes patient safety a priority in clinical practice
• Raises and escalates concerns where there is an issue with patient safety or quality of care
• Demonstrates commitment to learning from patient safety investigations and complaints
• Shares good practice appropriately
• Contributes to and delivers quality improvement
• Understands basic Human Factors principles and practice at individual, team, organisational and system levels
• Understands the importance of non-technical skills and crisis resource management
• Recognises and works within limit of personal competence
• Avoids organising unnecessary investigations or prescribing poorly evidenced treatments

• Manages clinical information / data appropriately
• Understands principles of research and academic writing
• Demonstrates ability to carry out critical appraisal of the literature
• Understands the role of evidence in clinical practice and demonstrates shared decision making with patients
• Understands public health epidemiology and global health patterns
• Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches in scientific enquiry
• Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice
• Follows guidelines on ethical conduct in research and consent for research
• Recognises potential of applied informatics, genomics, stratified risk and personalised medicine and seeks advice for patient benefit when appropriate

• Delivers effective teaching and training to medical students, junior doctors and other healthcare professionals
• Delivers effective feedback with action plan
• Able to supervise less experienced trainees in their clinical assessment and management of patients
• Able to supervise less experienced trainees in carrying out appropriate practical procedures
• Able to act as a clinical supervisor to doctors in earlier stages of training

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns, priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Recognises need to liaise with specialty services and refers where appropriate

• Able to manage patients who have been referred acutely to a specialised medical service as opposed to the acute unselected take
• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns, priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Demonstrates appropriate continuing management of acute medical illness in a medical specialty setting
• Refers patients appropriately to other specialties as required

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Demonstrates effective consultation skills
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Demonstrates appropriate continuing management of acute medical illness inpatients admitted to hospital on an acute unselected take or selected take
• Recognises need to liaise with specialty services and refers where appropriate
• Appropriately manages comorbidities in medial inpatients
• Demonstrates awareness of the quality of patient experience

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Demonstrates effective consultation skills
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately manages comorbidities in outpatient clinic, ambulatory or community setting
• Demonstrates awareness of the quality of patient experience

• Demonstrates effective consultation skills (including when in challenging circumstances)
• Demonstrates management of medical problems in inpatients under the care of other specialties
• Demonstrates appropriate and timely liaison with other medical specialty services when required

• Applies management and team working skills appropriately, including influencing, negotiating, continuously re-assessing priorities and effectively managing complex, dynamic situations
• Identifies appropriate discharge plan
• Ensures continuity and coordination of patient care through the appropriate transfer of information demonstrating safe and effective handover
• Effectively estimates length of stay
• Delivers patient centred care including shared decision making
• Recognises the importance of prompt and accurate information sharing with primary care team following hospital discharge

• Demonstrates prompt assessment of the acutely deteriorating patient, including those who are shocked or unconscious
• Demonstrates the professional requirements and knowledge of legal processes associated with consent for resuscitation
• Participates effectively in decision making with regard to resuscitation decisions, including decisions not to attempt CPR, and involves patients and their families
• Demonstrates competence in carrying out resuscitation

• Identifies patients with limited reversibility of their medical condition and determines palliative and end of life care needs
• Identifies the dying patient and develops an individualised care plan, including anticipatory prescribing at end of life
• Demonstrates effective consultation skills in challenging circumstances
• Demonstrates safe and effective use of syringe pumps in the palliative care population
• Able to manage non complex symptom control including pain
• Facilitates referrals to specialist palliative care across all settings
• Demonstrates compassionate professional behaviour and clinical judgement

• Maximise the effectiveness of the Acute Medicine Unit (AMU)
• Enables prompt decision making and patient communication in acute medical patients
• Enables making multiple decisions or manage the care of multiple patients progressing in one time period
• Enables care for patients with diagnostic uncertainty in the appropriate environment
• Demonstrate ability to function well in situations with multiple and disparate demands on time
• Deliver safe and effective handover
• Demonstrate an advanced understanding of capacity and flow across the organisation
• Ensure staffing and resources are optimal for delivery of care
• Coordinate the multidisciplinary team (MDT) input into the care of patients in one environment to enable optimal use of resources to prevent duplication, replication or waste of resources
• Enable the delivery of good quality education, supervision and training of the multidisciplinary team
• Are responsive to patient feedback including from hard to reach groups
• Facilitate development of protocols and pathways
• Reflect a knowledge of roles in multi-professional interaction such as: Pharmacy e.g. Medicines reconciliation, Early supported discharge/intervention team

• Interaction with community partners and the Emergency Department
• Interaction with radiology
• Identification of patients suitable for ambulatory management
• Use of appropriate risk stratification tools where available to identify patients suitable for SDEC
• Education of junior staff and other specialities in the role of SDEC
• Development of ambulatory pathways
• Development of pathways to optimise patient flow
• Delivery of ambulatory procedures where appropriate
• Assessment of the efficiency of the SDEC service
• The identification of changes to work practices that can improve the efficiency of the care delivered
• Equity of access, and a suitable environment for adolescents and young adults, LGBTQ+, BAME groups and those with learning and neurodevelopmental difficulties

• Demonstrate awareness of issues that can compromise patient safety
• Identify the appropriate pathway for the management of the acutely unwell patient
• Use and develop risk stratification tools to identify the best place for initial and ongoing management of patients
• Provide assessment, stabilisation and management of an acutely unwell medical patient
• Once the patient has been stabilised, to determine the most appropriate place for the ongoing management i.e. inpatient or outpatient
• Identifies patients who are in the terminal phase of their life on presentation to prevent unnecessary harm to the patient and unnecessary use of resources

• Promote development of resilient relationships and communication with the Emergency Department, Intensive Care, and other Specialties including Cardiology, Respiratory and Geriatric medicine
• Facilitate prompt risk stratification
• Demonstrate airways management skills – up to and including supraglottic airway adjuncts
• Demonstrate appropriate use of vasoactive and inotropic drugs
• Demonstrate appropriate use of the various types of non-invasive respiratory support e.g. BiPAP, CPAP and high flow nasal cannula
• Demonstrate knowledge of the appropriate methods for monitoring (invasive and non- invasive) the circulatory system
• Provide advanced management for critically unwell patients in the first 72 hours of hospital stay
• Facilitate treatment escalation planning, especially in the frail population
• Co-ordinates the care of the acute unwell medical patient with critical care with effective handover

• Enable the co-ordination of the roles and duties of multiple and different professionals working on the AMU/SDEC unit to facilitate safe and effective discharge planning
• Optimise patient flow from the community and ED into AMU and then to the downstream wards and back to the community
• Enable rapid resolution of clinical enquiries from primary care to facilitate patient flow and reduce unnecessary investigations and admission to secondary care
• Ensure that all clinicians involved in the care of complex patients receive adequate communication to ensure safe and effective discharge – including liaison with named lead clinician in adult and/or older persons mental health services, CAMHS

• Demonstrate the development of a specialty skill relevant to the practice of Acute Internal Medicine

Currency Window

Evidence of your recent practice will be given more weight to reflect current capabilities and we suggest that approximately 50% of your evidence for a curriculum outcome is drawn from within the last five years of clinical practice (WTE).

Evidence Volume

around 100 electronically uploaded documents