Geriatric Medicine 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
• 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

• Performs a comprehensive assessment which includes physical, functional, social, environmental, psychological and spiritual concerns
• Performs an assessment of cognition (including acute, chronic and rapidly deteriorating) and mental capacity
• Performs an assessment of nutritional state
• Demonstrates appropriate continuing management of acute medical illness and appropriately manages comorbidities
• Performs a medication review and is able to optimise and manage medicines in patients living with multi-morbidity and frailty
• Formulates an appropriate differential diagnosis and develops a problem list
• Evidence should be provided for each setting – in-patient, out-patient and community
• Performs a risk assessment of peri-operative morbidity

• Assesses and manages older patients presenting with falls (with or without fracture)
• Assesses and manages older patients presenting with syncope
• Assesses and manages patients with dementia who present with other illnesses
• Recognises and manages older people with common movement disorders
• Assesses and manages older people with urinary and faecal incontinence
• Assesses and manages older people who present with immobility and declining mobility
• Assesses and manages common types of leg and pressure ulceration, surgical and other wounds in older patients
• Assesses, diagnoses and manages patients who present with acute stroke and contributes to a comprehensive service for patients with chronic stroke-related disability
• Recognises, diagnoses and manages a state of delirium presenting both acutely or sub-acutely and identifies those who require follow up
• Assesses, diagnoses and manages older people who present with dementia
• Demonstrates advanced diagnostic and communication skills, develops a problem list, appropriately selects, manages and interprets investigations
• Identifies patients with limited reversibility of their medical condition, is able to discuss end of life, undertake advance care planning conversations and determine palliative care needs

• Demonstrates the ability to screen for and assess patients presenting with a frailty syndrome
• Assesses and manages clinical presentations in older people with moderate and severe frailty, and appropriately manages comorbidities
• Performs a medication review and is able to optimise and manage medicines in patients living with multi-morbidity and frailty
• Recognises the impact of frailty on the management and prognosis of patients living with chronic conditions (e.g., heart failure)
• Demonstrates the ability to recognise non-specific acute presentations seen in older people, and secondary complications of acute illness with strategies to prevent this
• Intervenes to improve outcomes for frail older people in a variety of settings
• Identifies patients with limited reversibility of their medical condition or uncertain prognosis, is able to discuss treatment escalation and DNACPR decisions
• Demonstrates the ability to advocate for frail older people

• Demonstrates the ability to assess physical function, mood and cognition using appropriate scales in hospital, in the community and in other settings
• Appropriately manages co-morbidities, including frailty and dementia
• Identifies and manages barriers to communication and demonstrates effective consultation skills
• Appropriately assesses patients for rehabilitation in medical, orthopaedic, and surgical wards, and identifies those suitable for community rehabilitation
• Identifies patients with limited reversibility of their medical condition
• Applies management and team working skills appropriately, including influencing, negotiating, continuously re-assessing priorities and effectively managing complex, dynamic situations and promotes a rehabilitation ethos
• Leads a multidisciplinary team meeting, facilitates discussion, builds rapport, and resolves conflicts as they arise
• Applies the principles of specialist rehabilitation services (including orthogeriatric and stroke)
• Effectively estimates length of stay, identifies an appropriate discharge plan, and ensures prompt and accurate information sharing with primary care team following hospital discharge
• Able to discuss end of life and advance care planning to enable patients to make preferences known and ensure end of life care needs are appropriately identified and met

• Performs a comprehensive assessment of older people in community settings
• Manages acute illness, comorbidities (including dementia) and other problems safely in community settings
• Able to discuss uncertainty and balance benefits/burdens of hospital versus home treatment
• Manages rehabilitation in community settings, including patient’s homes, care homes and community inpatient rehabilitation
• Performs an assessment of mental capacity
• Performs a medication review
• Formulates an appropriate differential diagnosis, problem list, and individualised management plan taking into account patient preferences
• Understands the various agencies involved in community care

• Contributes to peri-operative management of common co-morbid conditions
• Demonstrates understanding of surgical and anaesthetic issues, postoperative care, and complications
• Demonstrates the ability to clinically assess hip fracture patients, including pre-operative assessment and management, acute post-operative care, post-surgical rehabilitation, and discharge planning
• Contributes to the assessment and management of patients in critical care areas Including discussion of uncertain prognosis, limited reversibility, and treatment escalation
• Works collaboratively with orthopaedic surgeons, anaesthetists, cardiologists, and other professionals
• Promotes multidisciplinary team working
• Appropriately assesses bone health and manages osteoporosis
• Demonstrates the ability to assess patients for rehabilitation in medical, orthopaedic, and surgical wards
• Appropriately assesses and manages older people with acute and chronic medical problems in psychiatry wards and other settings
• Identifies patients with limited reversibility of their medical condition and determines palliative and end of life care needs
• Demonstrates the ability to contribute to older people’s physiological management in multiple settings

• Ensures patient safety is a priority in clinical practice and 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 and develops services accordingly
• Contributes to, and delivers, quality improvement with a particular focus on services for older people and those living with frailty
• Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice
• Understands management of services, including performance measures, and principles of commissioning where appropriate
• Demonstrates ability to carry out critical appraisal of the literature and understands the role of evidence in clinical practice and its limitations in an older population
• Understands public health epidemiology and global health patterns
• Delivers effective teaching and training, with specific reference to older people
• Demonstrates leadership and management skills, including working with others to effect change
• Acts as an advocate for older people and is able to challenge ageist practices
• Understands the principles of partnership working between health and social care
• Understands local, national and UK health priorities and how they impact on services for older people living with frailty

• Demonstrates the ability to manage older people with fractures, including hip fractures, other fractures, polytrauma
• Demonstrates the ability to manage the effects and risks of surgery and anaesthesia in older people
• Demonstrates the ability to clinically assess and manage older people with fractures and multi-morbidity peri-operatively
• Demonstrates greater knowledge and ability to manage surgical complications
• Demonstrates ability to manage patients with osteoporosis treatment failure
• Demonstrates greater ability to manage patients requiring parenteral osteoporosis therapy
• Demonstrates awareness of different anaesthetic options for patients with complex co-morbidity

• Demonstrates the ability to perform a detailed assessment of patients presenting with urinary or faecal incontinence
• Demonstrates the ability to perform bladder scans and understand urodynamic testing
• Demonstrates the ability to interpret the results of investigations (including multichannel cystometry and anal ultrasound and manometry)
• Performs a detailed medication review
• Selects treatment options for patients with bowel and bladder problems
• Demonstrates the ability to collaborate with specialist nursing, therapy and surgical colleagues
• Possesses the knowledge and skills required to develop an integrated continence service for older people

• Demonstrates advanced skills in undertaking a comprehensive assessment of older people in community settings
• Manages acute illness, comorbidities (including dementia) and other problems safely in community settings
• Demonstrates excellent risk assessment and management skills in identifying the most appropriate place of care
• Appropriately manages patients with pre-existing learning disability in a community setting
• Leads rehabilitation in a community setting, and demonstrates advanced skills in managing and contributing to community MDT working
• Understands the various agencies involved in community care
• Delivers a flexible approach to care which crosses the traditional division between primary and secondary care
• Identifies patients with limited reversibility of their medical condition and determines palliative and end of life care needs
• Demonstrates advanced skills in care home medicine
• Demonstrates skills in education and management of community staff
• Possesses the knowledge and skills required to develop a community geriatric medicine service for older people

• Demonstrates the ability to clinically assess, diagnose and manage patients presenting with a wide variety of movement disorders
• Demonstrates the ability to manage patients presenting with Parkinson’s Disease (PD) at any stage
• Recognises and appropriately manages patients with Dementia with Lewy Bodies, PD related dementia, impulse control disorders, dopamine dysregulation syndrome and Dopamine agonist withdrawal syndrome
• Possesses the knowledge and skills required to develop a comprehensive movement disorder service for older people
• Demonstrates the ability to work collaboratively with neurologists, old age psychiatrists and other professionals
• Performs an assessment of mental capacity, including in challenging circumstances
• Demonstrates appropriate continuing management of acute medical illness and appropriately manages comorbidities
• Performs a medication review including acute management of patients with impaired swallow or absorption
• Identifies patients with limited reversibility of their medical condition and determines palliative and end of life care needs

• Demonstrates ability to conduct an urgent acute clinical evaluation and prioritise safely
• Able to provide an accurate diagnosis and appropriate comprehensive management of patients with suspected TIA or minor stroke
• Demonstrates recognition of conditions that mimic TIA and stroke in the context of systemic disease
• Awareness of up to date primary and secondary prevention treatment strategies for TIA and minor stroke
• Ability to prioritise referrals received through different mechanisms
• Provides appropriate driving, vocational and social advice for patients with TIA or stroke
• Appropriate management of comorbidities and risk factors relevant to TIA and minor stroke in an outpatient clinic
• Able to apply principles of stroke team multi-professional assessment to understand the physical and psychological and social impact of stroke

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