Palliative 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 (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

• Demonstrates ability to: Undertake a holistic palliative care assessment; and to formulate, prioritise, communicate and implement an effective palliative care plan
• Manage a caseload of patients with complex palliative care problems across a range of care settings and promote coordinated care, in and out of hours
• Understand the impact of multi-morbidity, advanced ageing and frailty in people with life-limiting conditions
• Effective management of medical emergencies across all palliative care settings, including determining when intervention is inappropriate and how to manage this in the patient’s usual residence if appropriate
• Ability to support patients and those close to them to identify meaning in their lives, enhance well-being and where appropriate, support people to focus towards realistic hopes and goals
• Understanding of and application of the ethical and legal frameworks of decision-making in teenagers and young adults
• Awareness of the specific needs of those in hard to reach or marginalised groups that traditionally struggle to access palliative care services

• Up-to-date knowledge, understanding and skills to assess and manage complex pain secondary to life-limiting progressive disease, taking into account patient preferences and reversibility
• Knowledge of the pathophysiology of pain to inform pain assessment and management
• Application of evidence-based knowledge and skill in the effective use of non-pharmacological management, opioid & non-opioid analgesics to manage complex pain, including safe prescribing in patients with organ failure, frailty and low body weight or who are in the last hours or days of life
• Knowledge of managing pain whilst minimising longer term adverse effects in those with progressive disease but longer prognoses
• Appropriate knowledge of interventional pain techniques to effectively manage complex pain that is not responding to conventional treatments
• Ability to refer to and share care with other pain services
• Ability to safely manage pain in the context of drug misuse and dependence

• Advanced skills in the identification and assessment of physical, psychological and psychiatric symptoms in patients with progressive life-limiting illnesses and ability to formulate clear, individualised management plans taking into account patient preferences and reversibility
• Advanced understanding of the pathophysiology of symptoms to inform assessment and management
• Application of evidence-based knowledge and skill to manage physical symptoms in life-limiting illness across a range of systems
• Application of appropriate knowledge and skill in managing mental health/psychiatric issues in patients with life limiting conditions, including awareness of when to refer to specialist mental health services
• Ability to effectively use non-pharmacological interventions for symptoms to treat patients with life-limiting progressive disease
• Detailed understanding of pharmacology and therapeutics of drugs used for managing physical and psychiatric symptoms, including safe prescribing in patients with organ failure, frailty and low body weight or who are actively dying
• Appropriate knowledge of the use of drugs outside their product license and the legislation relevant to safe prescribing in NHS and third sector organisations

• Demonstration of advanced communication skills, including ability to consult, negotiate and involve patients and those close to them in their care
• Demonstrates ability to focus on the positive goals for patients and their families, to make the most of time remaining
• manage complex and challenging situations with patients, those close to them and colleagues
• facilitate effective communication of complex issues and information as patients transfer across settings
• identify obstacles to communication and skills in overcoming these
• Ability to enhance communication across organisations and care settings, to support the multi-professional team managing people with life-limiting illness
• Awareness of advantages of using technology to aid clinical assessment and communication in the palliative care population
• Awareness of opportunities and limitations for people in creating and managing digital legacies via social media platforms
• Ability to advocate for vulnerable patients with life-limiting conditions and those close to them and to navigate ethical and legally challenging situations
• Ability to provide an expert opinion for other specialties on complex ethical or legal issues relevant to palliative care
• Demonstrates an awareness of the skills needed to communicate with teenagers and young adults and to support development of self-determination/emerging autonomy

• Ability to recognise (and support other clinicians to recognise) dying, including an understanding of clinical uncertainty and limited reversibility in people with progressive life-limiting conditions
• Safe implementation of anticipatory care for patients who are approaching the last days of life, including prescribing, advance care planning, escalation plans and establishing priorities for care
• Ability to proactively support other professionals in developing effective management strategies and plans for caring for dying patients
• Ability to coordinate palliative care and support teams caring for those with specific needs such as learning disability or complex mental health needs
• Safe and effective use of medication in the dying phase to manage common and complex symptoms
• Ability to judge the appropriateness of interventions in dying patients
• Awareness of the role environment plays in caring for the dying patient and ability to adapt accordingly
• Ability to identify and manage distress at the end of life in patients (and those close to them) and colleagues
• Demonstrates detailed understanding and application of the ethical and legal frameworks and legislation supporting decision making at the end of life
• Development of expert skills in ethical reasoning and decision-making in end-of-life care
• Awareness of dying as a social process; appreciates and facilitates the role of a wider social network and non-professional support at this time

• Ability to identify, assess and manage complex psychosocial issues affecting patients and those close to them and healthcare professionals in the context of life-limiting disease
• Ability to utilise the multi-professional team, across care settings and between services, to provide customised patient-centred care for patients with complex psychosocial issues
• User of appropriate knowledge and skill to support patients and those close to them in dealing with distress, loss and grief
• Awareness of the range of psychological interventions that can be used to support patients and those close to them
• Knowledge of the responses and needs of children or adults with learning difficulties
• Knowledge of and skills in recognising and managing mental illness in patients with life limiting conditions
• Ability to recognise and manage agitated, violent and/or suicidal patients and/or those close to them
• Awareness of rehabilitation approaches to maximise physical and social functioning in the context of advanced life-limiting illness
• Knowledge of financial and welfare benefits available
• Awareness of the positive and negative impacts of caring on those close to patients with life-limiting illness
• Awareness of need for people and those close to them to maintain social participation and support networks
• Awareness of and ability to work alongside the community and social resources available to support vulnerable people
• Knowledge and skills to elicit spiritual concerns and to recognise and respond to spiritual distress; and respects differing spiritual beliefs and practices
• Understanding of the impact of culture, ethnicity and sexuality in response to life-limiting conditions and at the end of life

• Demonstrates ability to synthesise complex clinical and psychosocial information leading to patient-centred decision-making in all settings
• Ability to provide an expert opinion in situations where there is clinical uncertainty or conflict with patients and/or those close to them
• Ability to coordinate care across settings in collaboration with hospital and community providers to optimise patient centred care and use of resources
• Ability to collate information from all members of the multidisciplinary team and, if necessary, appropriately challenge other senior healthcare professionals
• Demonstrates ability to support, educate, influence and develop members of the wider multi-professional team to deliver high quality palliative care across all care settings
• Engagement with palliative care research, audit and quality improvement to inform service development and evaluation across settings
• Awareness of understanding population needs, including remote or rural communities, when developing and delivering palliative care services
• Understanding of the principles of financial management of palliative care services in the NHS and third sector
• Understanding of the management of pharmacy budgets and regulatory aspects of controlled drugs, particularly in third sector organisations
• Effective leadership, negotiation and management skills, including involvement in strategy and management of palliative care services across care settings
• Understanding of the structures that support effective leadership and management in NHS and third sector organisations, including the role of volunteers, fundraising teams and trustees
• Awareness of the range of strategies that could be utilised to deliver sustainable healthcare services across all settings, including third sector

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