Respiratory Medicine with General Internal Medicine (GIM) CESR Portfolio Guide

Generic Capabilities in Practice

• 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

Generic Capabilities in 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

Generic Capabilities in Practice

• 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

Generic Capabilities in Practice

• 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

Generic Capabilities in Practice

• 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

Generic Capabilities in Practice

• 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

Clinical Capabilities in Practice

• 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

Clinical Capabilities in Practice

• Able to manage patients who have been referred acutely to a specialised medical service as opposed to the acute unselected take (e.g. cardiology and respiratory medicine acute admissions)
• 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

Clinical Capabilities in Practice

• 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 (unselected take, selected acute take or specialty admissions)
• Demonstrates awareness of the quality of patient experience

Clinical Capabilities in Practice

• 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

Clinical Capabilities in Practice

• 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

Clinical Capabilities in Practice

• 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

Clinical Capabilities in Practice

• 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

Clinical Capabilities in Practice

• 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

Specialty Specific Capabilities in Practice

• Demonstrate appropriate behaviour towards patients and relatives, especially in the context of breaking bad news
• Demonstrates diagnostic acumen
• Ability to perform relevant diagnostic tests and procedures
• Demonstrates appropriate behaviour to clinical and other professional colleagues
• Communication with GP and specialist colleagues
• Ability to construct decision algorithms (e.g. planning in advance the different possible courses of action resulting from investigation results)
• Knowledge of principles and evidence behind screening
• Demonstrates compassion and care
• Knowledge of guidelines and ability to apply them to practice

Specialty Specific Capabilities in Practice

• Demonstrates appropriate behaviour with regard to patients
• Demonstrates ability to apply guidelines to practice
• Demonstrates expertise in the management of airway disease and provides guidance to non-respiratory specialists
• Understands how to set up integrated respiratory services (including relevant NHS structures, business cases, commissioning, tendering processes)
• Demonstrates practical application of “Hospital at Home” and admission avoidance systems
• Works in partnership with the Respiratory Multi-disciplinary team (e.g. physiotherapists, specialist nurses, palliative care team, pharmacists, physiologists and psychologists)
• Is able to refer patients for pulmonary rehabilitation and participate in delivery
• Demonstrates skills in smoking cessation techniques
• Understands impact of air pollution in lung disease and contributes to measures to improve air quality
• Understands psychological interventions e.g CBT

Specialty Specific Capabilities in Practice

• Demonstrates accurate diagnosis of patients presenting with pulmonary infections including interpretation of clinical features, investigations and laboratory results
• Demonstrates knowledge and interpersonal skills in dealing with immunocompromised patients
• Demonstrates appropriate management of patients diagnosed with pulmonary infections including appropriate selection of drugs
• Shows awareness of broader aspects of pulmonary infections especially public health issues including notification and contact tracing of patients with specific infections

Specialty Specific Capabilities in Practice

• Demonstrate an understanding of the role of the respiratory physician in the management of critically ill patients
• Show recognition of patients who will and will not benefit from intensive care or from care in an HDU
• Demonstrate knowledge and skill in managing oxygen therapy in the acute and domiciliary settings
• Demonstrate understanding of and the skills required to provide non-invasive ventilation for acute and acute on chronic respiratory failure in hospital
• Demonstrate understanding of and the skills needed to provide non-invasive ventilation for chronic respiratory failure in the community

Specialty Specific Capabilities in Practice

• Demonstrates ability to consider the diagnosis of pulmonary hypertension, occupational lung disease, allergy, cystic fibrosis and other orphan lung diseases
• Knowledge of diagnostic criteria for rare lung diseases
• Identification of patients to be considered for lung transplantation and appropriate investigations and treatments before and after transplantation
• Presentation of cases at specialist MDT
• Demonstrates good communication skills when dealing with tertiary centres
• Demonstrates knowledge of these disorders and ability to manage patients in a joint care model when appropriate

Specialty Specific Capabilities in Practice

• Accurate diagnosis of patients presenting with respiratory problems on an acute unselected take or in a respiratory clinic
• Demonstrates knowledge of the pharmacology of respiratory drugs and delivery systems
• Familiarity with relevant therapeutic guidelines
• Ability to perform relevant therapeutic procedures
• Demonstrates ability to liaise with speciality services when required
• Recognises the importance of prompt and accurate information sharing with primary care team following hospital discharge

Currency Window

Evidence which demonstrates that you have met a curriculum outcome can be drawn from any point in your career. However, there should be corresponding evidence of recent (within the last five years of clinical practice (WTE)) to confirm the maintenance of the skill or competency. 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