General Internal Medicine (GIM) CESR Portfolio Guide
Complete guide to the General Internal Medicine (GIM) Portfolio Pathway: 14 Capabilities in Practice (CiPs), 4 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 General Internal Medicine (GIM) SSG defines 14 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 focussed 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
Evidence Requirements
The SSG specifies 4 evidence sections. Each section describes what evidence to provide and how to present it.
Evidence of training, qualifications, and employment
Evidence of your training as background evidence to allow evaluators to see your whole career pathway.
What to provide
- Primary medical qualification (PMQ)
- Specialist medical qualification(s) (e.g., MRCP(UK) or comparable)
- Recent specialist training curriculum/syllabus and formal periodic assessments
- CV
- Employment letters
- Job descriptions
- Rotas (samples from last 3 years)
- Appraisal or performance reviews
How to present
Submit electronically under the correct section of your online application. Group evidence together to keep individual uploads manageable.
Practical Procedures
Evidence of practical procedures and the level of competency expected.
What to provide
- Logbooks
- Direct Observation of Procedural Skills (DOPS)
- Structured report concentrating upon core procedural skills
How to present
Provide one summative DOPS for each procedure for which an applicant must be competent to perform unsupervised, or a structured report.
Generic CiPs
Evidence supporting the 6 generic capabilities in practice.
What to provide
- Multiple Consultant Report (MCR)
- Multisource Feedback (MSF)
- Evidence of governance/service development (e.g., QIPAT, meeting minutes)
- CPD evidence (courses in management, business, simulation, communication, research methodology, education)
- Reflective diaries
- Patient Survey
- Mini-CEX
- Evidence of mental capacity assessments
- Evidence of research activity (GCP training, publications, presentations)
- Teaching Observation (TO)
How to present
Cross-reference evidence where it supports more than one CiP.
Clinical CiPs
Evidence demonstrating current practice at the level of 'entrusted to act independently' in all clinical CiPs.
What to provide
- Multiple Consultant Report (MCR)
- Multisource Feedback (MSF)
- Acute Care Assessment Tool (ACAT)
- Case-based discussion (CbD)
- Mini-CEX
- Outpatient Care Assessment Tool (OPCAT)
- Direct observation of procedural skills (DOPS)
- Patient Survey
- Discharge summaries
- ALS certificate
- Written reflections on learning and experience
- Evidence of simulation
How to present
Cross-reference evidence where it supports more than one CiP.
Index Procedures
13 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 |
Knowledge Requirements
Primary Path
Evidence of completion of full MRCP(UK) or comparable qualification.
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.
The MRCP(UK) is comprised of three tests, designed to assess acquisition of the full range of knowledge, skills and behaviour, as well as clinical understanding and execution, as detailed in the UK curriculum for Core Medical/Internal Medicine Training.
Referee Requirements
Referee Reports Required
Recent
- Current Head of Department or other senior colleague with knowledge of the breadth of your clinical activity (ideally an Educational Supervisor with at least 5 years experience)
- One Internal medicine referee of consultant level who is 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.
Acute Care Assessment Tool (ACAT)
ACATs that indicate the applicant is performing in an independent manner at Entrustment level 4
Outpatient Care Assessment Tool (OPCAT)
OPCATs to level 4 entrustment
Case-based discussion (CbD) and/or mini-clinical evaluation exercise (mini-CEX)
SLEs comprised of a mix of CbDs and Mini-CEXs to level 4 entrustment
Quality Improvement Project Assessment Tool (QIPAT)
QI project with evidence of completion
Patient Survey (PS)
Formal patient feedback including approximately 15 patients
Teaching observation (TO)
Completed by a consultant in the specialty
Multi Source Feedback (MSF)
Anonymous feedback exercise including approximately 12 colleagues
Multiple Consultant Report (MCR)
Supervisor reports 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
Do not submit original documents. You must provide your evidence electronically.
Anonymise (redact) identifiable information.
Triangulated evidence (evidence comprised of three different sources) will make a stronger application.
Evidence of your recent practice (<within the last 5 years of clinical practise (WTE)) will be given more weight.
Don’t duplicate evidence that is relevant to more than one CiP – you should include one copy and then list it under each relevant CiP (cross referencing).
Evidence should only be cross referenced where it adds significant support to a CiP.
If you do not hold registration, you will need to have your PMQ independently verified before we can grant you full registration with a licence to practise.
Frequently Asked Questions
What is the General Internal Medicine (GIM) CESR portfolio?
How many framework units does General Internal Medicine (GIM) require?
What evidence is required for General Internal Medicine (GIM) specialist registration?
How long is the currency window for General Internal Medicine (GIM)?
What index procedures are required for General Internal Medicine (GIM)?
Related Specialties
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