The terminology of "General" and "Acute" medicine has caused some confusion in recent years. Many consultant physcians are "dually accredited" in a specialty plus general medicine; for example most respiratory physicians have dual accreditation in respiratory and general medicine. In modern practice their commitment to general medicine will mostly involve the acute care of patients admitted from the acute medical take. Few consultants still practice as truly general physicians in the sense of having no specific specialty interest; although consultants in smaller district general hospitals are likely to have a more generalist range of practice than those working in larger hospitals. This sometimes puts an onus on referring general practitioners to decide which specialty is most apropriate to manage their patient; particularly when they are uncertain of the diagnosis.

The new specialty of Acute Medicine aims to train doctors to the level of expertise required to run a Medical Admissions Unit (Level 3 competency in Acute Medicine) whereas dual accreditation in General Medicine (Level 2 competency in Acute Medicine) involves competence to contribute as the consultant physician on the acute take but without overall responsibility for an Medical Admissions Unit.

There is currently a problem that trainees in acute medicine who achieve level 3 competency, with the intention of becoming consultant acute physicians, will only be acredited in general medicine; even though they will have become "specialists" in acute medicine. This paradox is due to European law which currently will not distinguish the specialty of acute medicine from general medicine. JRCPTB is currently reviewing this situation in an attempt to find a new name for acute medicine as a specialty in order to resolve this. In the meantime, however, trainees completing level 3 competency and who need to be able to confirm this for potential employers can ask JRCPTB to provide written confirmation.

General and Acute Statement on Dual CCT - Feb 2009

Dual Certificates of Completion of Training (CCTs) with General Internal Medicine (GIM) and another Medical Specialty.

This meeting was convened to address concerns that have been expressed by trainees, and supervisors concerning the doctors recruited to train in August 2007 and 2008 in medical specialties and GIM. This group of doctors had been informed that they would receive a single CCT in their chosen specialty, and that their achievement of level 2 competence in the GIM curriculum (August 2007) (sufficient to lead the medical “take”) would be recognised by receipt of a ‘credential’ from the JRCPTB.

Recent plans to develop Acute Internal Medicine as a specialty in its own right, and to develop a new curriculum for GIM from August 2009 heightened the concerns of trainees recruited in 2007 and 2008. Most trainees in acute medical specialties wish to be able to achieve dual CCTs in GIM and another medical specialty (see PMETB website for the June 2007 guidance on dual CCTs).

It is recognised that the needs of patients as identified by the Service require physicians whose competence in GIM and, therefore, ability to manage the acute take is clearly defined. PMETB, the JRCPTB, COPMeD, and trainees wish to ensure that those signed up to the current Level 2 ‘credential’ (all those trainees who commenced training in GIM within their chosen medical specialty in 2007 and 2008) are not perceived to be disadvantaged by not having the appropriate dual CCT qualifications.

As a result, and in parallel with the development of the new GIM curriculum, JRCPTB are undertaking a mapping process that will enable these trainees to transfer to the new curriculum. They can then expect to exit training, subject to successful completion of the PMETB approved training programme and assessments, with dual CCTs, one in GIM and one in another medical specialty.

We expect that the additional competencies required for the CCT in GIM in addition to those required for the other specialty CCT can be achieved by StRs within a reasonable (EU minima) time period. Therefore, the expectation is that all trainees who commenced training at ST3 level in 2007 or 2008, and who want to acquire competence to lead the acute medical “take” will switch to the new GIM curriculum. On successful completion of the training programme and assessments for both specialties, as outlined in the relevant PMETB approved curricula, the Doctor will achieve two CCTs, one in GIM and another medical specialty.

These developments must be approved by PMETB prior to implementation. For further information, contact JRCPTB.

Please note that in regard to fees for CCT, a doctor pays the fee per application. If s/he applies for both CCTs at the same time (that is in one application), s/he pays one fee. If s/he applies at separate times (that is in two applications), s/he pays twice.