Gastroenterology with General Internal Medicine (GIM) CESR Portfolio Guide
Complete guide to the Gastroenterology with General Internal Medicine (GIM) Portfolio Pathway: 22 Capabilities in Practice (CiPs), 5 evidence sections, and a 5-year currency window. Based on official GMC Specialty Specific Guidance, published by Joint Royal Colleges of Physicians Training Board (JRCPTB).
SSG Version: 31/01/2025
Capabilities in Practice (CiPs)
The Gastroenterology with General Internal Medicine (GIM) SSG defines 22 Capabilities in Practice (CiPs) that Portfolio Pathway applicants must demonstrate competence in.
Able to function successfully within NHS organisational and management systems
- 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
Able to deal with ethical and legal issues related to clinical practice
- 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 effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement
- 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
Is focused on patient safety and delivers effective quality improvement in patient care
- 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
Carries out research and manages data appropriately
- 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
Acts as a clinical teacher and clinical supervisor
- 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
Managing an 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
- Recognises need to liaise with specialty services and refers where appropriate
Managing the acute care of patients within a medical specialty service
- 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
Providing continuity of care to medical inpatients, including management of comorbidities and cognitive impairment
- 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
Managing patients in an outpatient clinic, ambulatory or community setting (including management of long term conditions)
- 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
Managing medical problems in patients in other specialties and special cases
- 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
Managing a multi-disciplinary team including effective discharge planning
- 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
Delivering effective resuscitation and managing the acutely deteriorating patient
- 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
Managing end of life and applying palliative care skills
- 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
Manage care of Gastroenterology and Hepatology in-patients
- Demonstrates behaviour appropriately with regard to patients
- Demonstrates behaviour appropriately with regard to clinical and other professional colleagues
- Demonstrates effective communication skills including challenging circumstances
- Demonstrates ability to negotiate shared decision making
- Demonstrates leadership skills
- Demonstrates effective skills in managing patients on home ward/through outreach within the organisation
- Demonstrates timely involvement with other clinicians as appropriate
Managing care of Gastroenterology and Hepatology patients in an out-patient environment
- Appropriate professional behaviours with regard to patients
- Appropriate professional behaviours with regard to clinical and other professional colleagues
- Effective communication, including challenging circumstances
- Ability to negotiate shared decision making
- Leadership
- Appropriate liaison with other services
Managing care of patients with complex disease across multiple care settings, including interaction with primary care and community networks
- Appropriate professional behaviours with regard to patients
- Appropriate professional behaviours with regard to clinical and other professional colleagues
- Effective communication, including challenging circumstances
- Ability to negotiate shared decision making
- Leadership
- Appropriate liaison with other services
Managing care pathways for patients with suspected and confirmed gastrointestinal and hepatic malignancy
- Appropriate professional behaviours with regard to patients
- Appropriate professional behaviours with regard to clinical and other professional colleagues
- Effective communication, including challenging circumstances
- Ability to negotiate shared decision making
- Leadership
- Appropriate liaison with other services
The ability to practice diagnostic and therapeutic upper GI endoscopy and in other practical skills undertaken/overseen by a Gastroenterology Consultant
- Appropriate professional behaviours with regard to patients
- Appropriate professional behaviours with regard to clinical and other professional colleagues
- Competence in assessing patients for endoscopic and other interventional procedures
- Competence in undertaking diagnostic and therapeutic endoscopic procedures
- Competence in performing other practical procedures
- Ability to teach skills to others
Contributing to the prevention of gastrointestinal and liver disease
- Professional behaviour with regard to patients, carers, colleagues and others
- Delivers patient centred care including shared decision making
- Effective consultation skills
- Formulates an appropriate diagnostic and management plan, taking patient preferences into account
- Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
- Applies knowledge of prevention and screening to individual patients and the local health system
- Demonstrates awareness of the quality of patient experience
Managing complex problems in luminal gastroenterology
- Demonstrates appropriate professional behaviours with regard to patients
- Appropriate professional behaviours with regard to clinical and other professional colleagues
- Effective communication skills including challenging circumstances
- Ability to negotiate shared decision making
- Effective skills in managing patients on home ward/through outreach within the organisation
- Timely involvement with other clinicians as appropriate
- Ability to work within networks of care to deliver optimal outcomes
- Competence in assessing patients for colonoscopy and other interventional procedures
- Competence in undertaking diagnostic and therapeutic colonoscopy
- Leadership skills
Managing complex problems in hepatology
- Demonstrates appropriate professional behaviours with regard to patients
- Appropriate professional behaviours with regard to clinical and other professional colleagues
- Effective communication skills including challenging circumstances
- Ability to negotiate shared decision making
- Leadership skills
- Effective skills in managing patients on home ward/through outreach within the organisation
- Timely involvement with other clinicians as appropriate
- Ability to work within networks of care to deliver optimal outcomes
Evidence Requirements
The SSG specifies 5 evidence sections. Each section describes what evidence to provide and how to present it.
Evidence of training and qualifications
Evidence of your training as background evidence to see your whole career pathway.
What to provide
- Primary medical qualification (PMQ)
- Specialist medical qualification(s) - MRCP(UK) or comparable
- Evidence of completion of the European Specialty Examination in Gastroenterology and Hepatology (ESEGH) or comparable qualification
- Recent specialist training curriculum or syllabus
- Formal periodic assessments completed during training
How to present
Authenticated copies, verified by provider
Evidence of employment in posts and duties (including training posts)
Evidence of employment history and duties.
What to provide
- CV
- Employment letters
- Job descriptions
- Rotas (samples drawn from the last three years of clinical practise)
- Departmental/Unit annual caseload statistics
- Appraisal or performance reviews
How to present
Match information in CV, submit consecutive weeks' rotas
Supervised Learning Events (SLEs)
Assessments undertaken with a consultant.
What to provide
- Acute Care Assessment Tool (ACAT)
- Outpatient Care Assessment Tool (OPCAT)
- Case-based discussion (CbD)
- Mini-clinical evaluation exercise (mini-CEX)
How to present
Mix of CbDs and Mini-CEXs covering different aspects of the specialty
Workplace Based Assessments (WPBAs)
Evidence for each procedure for which an applicant must be competent to perform unsupervised.
What to provide
- Direct Observation of Procedural Skills (DOPS)
- Quality Improvement Project Assessment Tool (QIPAT)
- Patient Survey (PS)
- Teaching observation (TO)
- Multi Source Feedback (MSF)
How to present
Summative DOPS, formal patient feedback, anonymous MSF
Other evidence
Additional evidence to be included in the portfolio.
What to provide
- Appraisal
- Reflective diaries/ evidence of self-reflection
- Supervisor report (Multiple Consultant Report - MCR)
- Training events
- Evidence of seeing patients
- Academic activities
- Management activities
- Structured reports
- Continuing Professional Development (CPD)
How to present
Grouped logically, cross-referenced where appropriate
Index Procedures
20 index procedures require procedural-based assessments (PBAs) with specified minimum assessors and competence levels.
| Procedure | Category | Min PBAs | Min Assessors | Min Level |
|---|---|---|---|---|
| Advanced cardiopulmonary resuscitation (CPR) | Internal Medicine Procedures | — | — | 4 |
| Direct current (DC) cardioversion | Internal Medicine Procedures | — | — | 4 |
| Temporary cardiac pacing using an external device | Internal Medicine Procedures | — | — | — |
| Central venous cannulation (internal jugular or subclavian) | Internal Medicine Procedures | — | — | — |
| Access to circulation for resuscitation (femoral vein or intraosseous) | Internal Medicine Procedures | — | — | — |
| Pleural aspiration for fluid (diagnostic) | Internal Medicine Procedures | — | — | 4 |
| Pleural aspiration (pneumothorax) | Internal Medicine Procedures | — | — | 4 |
| Intercostal drain for pneumothorax | Internal Medicine Procedures | — | — | — |
| Intercostal drain for effusion | Internal Medicine Procedures | — | — | — |
| Nasogastric (NG) tube | Internal Medicine Procedures | — | — | 4 |
| Ascitic tap | Internal Medicine Procedures | — | — | 4 |
| Abdominal paracentesis | Internal Medicine Procedures | — | — | — |
| Lumbar puncture | Internal Medicine Procedures | — | — | 4 |
| Diagnostic gastroscopy | Specialty Procedures | — | — | 4 |
| Haemostasis for GI bleeding | Specialty Procedures | — | — | 4 |
| Variceal banding | Specialty Procedures | — | — | 4 |
| PEG insertion | Specialty Procedures | — | — | 4 |
| Diagnostic colonoscopy | Specialty Procedures | — | — | 4 |
| Polypectomy Level 1 and 2 | Specialty Procedures | — | — | 4 |
| Large volume paracentesis | Specialty Procedures | — | — | 4 |
Special Interest Areas
Knowledge Requirements
Primary Path
MRCP(UK) and European Specialty Examination in Gastroenterology and Hepatology (ESEGH)
Alternative Path
A detailed, thorough and succinct cross-referencing mapping exercise, demonstrating how each and every competency in the qualification has been covered in your own qualifications.
If you do not hold the MRCP (UK) and ESEGH or a comparable qualification as above, you can aim to demonstrate the same level of knowledge by providing a portfolio of evidence.
Referee Requirements
Referee Reports Required
Current/recent
- Current Head of Department or other senior colleague (ideally Educational Supervisor with 5+ years experience)
- One Internal medicine referee of consultant level able to provide comments based on direct observation
- At least one other report from a colleague working with you at consultant level in your specialty
Volume and Assessment Targets
The SSG specifies minimum volume and assessment targets for this specialty.
ACATs (GIM)
Level 4 entrustment
ACATs (Gastroenterology)
Level 4 entrustment
OPCATs (GIM)
Level 4 entrustment
OPCATs (Gastroenterology)
Level 4 entrustment
SLEs (CbDs and Mini-CEXs) (GIM)
Level 4 entrustment
SLEs (CbDs and Mini-CEXs) (Gastroenterology)
Level 4 entrustment (around 3 per specialty CiP)
Summative DOPS for large volume paracentesis
Competent to perform unsupervised
Summative DOPS for gastroscopy in GI bleeding (to include variceal banding)
Competent to perform unsupervised
Summative DOPS for PEG insertion (Complex Luminal)
Competent to perform unsupervised
Quality Improvement Project Assessment Tool (QIPAT)
Active involvement in service audit or development projects
Patient Survey (PS)
Formal patient feedback (approx 15 patients)
Teaching observation (TO)
Completed by a consultant in the specialty
Multi Source Feedback (MSF)
Anonymous feedback exercise (approx 12 colleagues)
Multiple Consultant Report (MCR)
Supervisor report from trainers and supervisors
Currency Window & Evidence Volume
Currency Window
Years
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
Additional Notes
An application has been made to change the name of General Internal Medicine to Internal Medicine.
Triangulated evidence (evidence comprised of three different sources) will make a stronger application.
JAG (or equivalent) accreditation for gastroscopy is required.
JAG (or equivalent) accreditation for colonoscopy is required for Complex Luminal gastroenterology.
Applicants must also demonstrate one of two themed for service CiPs, tailored to practicing Gastroenterology in the NHS.
Frequently Asked Questions
What is the Gastroenterology with General Internal Medicine (GIM) CESR portfolio?
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What evidence is required for Gastroenterology with General Internal Medicine (GIM) specialist registration?
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What index procedures are required for Gastroenterology with General Internal Medicine (GIM)?
Related Specialties
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