Introduction To Higher Specialist Training

Individual specialties and information on the rotations involved are described under each specialty and these sections have been written by the relevant Training Programme Director or another consultant on the Training Committee who has been designated by them for this task. All the training programmes involve rotations through different hospitals in the school to provide experience in both District General Hospital and Regional Centre settings. Study days are organised by the Training Programme Directors and attendance at an agreed proportion of these meetings is mandatory.

The study day programme for General Internal Medicine is also compulsory for all specialties involving dual accreditation and these are organised by Dr Nabil Jarad, Respiratory/General Physician, Bristol Royal Infirmary.

A few rotations, notably Respiratory and Renal Medicine, are run jointly with the Peninsula School to provide trainees in both schools with the best opportunities to gain experience in sub specialty fields in Regional Centres. For these one school acts as the lead for the specialty with their Training Programme Director taking overall responsibility for the specialty and another consultant in the other school acting as their deputy.

More senior trainees who were appointed as SpR's in the Calman system will continue to be reviewed by the RITA (Record of In Training Assessment) process and continue their RITA portfolios. New higher specialty trainees entering ST3 from core training will be assessed by the ARCP system and will continue to use their eportfolios following on from the entries made in core training.

Principles of Higher Training

The duration of higher training varies with the medical specialty involved and one of the concepts of MMC is that it is competency based so that more able candidates may succeed in completing their training and receiving their Certificate of Completion of Training (CCT) earlier than their peers. From 2008 onwards higher training also involves passing an examination in the specialty. These examinations are just being set up in most specialties and generally involve a knowledge based test as opposed to the clinical skills and competencies that are documented through eportfolios and review each year at ARCP. While we do not have detailed knowledge yet on all specialties it appears that most specialties will decide that this examination can be taken at any time during higher training and it will be possible to retake it if not initially successful but the CCT can not be awarded until it has been passed.

Our understanding at present is that current Calman SpR’s will have the option to sit these examinations if they wish but they will not be compulsory.

The curriculum for each specialty is determined by the individual specialist society, e.g. The British Thoracic Society gives guidance on the curriculum for Respiratory Medicine, and then this is further monitored and updated by a national Specialist Advisory Committee (SAC) for each specialty which reports to JRCPTB. The national SAC for each specialty has representatives on it from all the Schools of Medicine in the country and these people are usually the Training Programme Directors for the specialty in their local school.

For the specialty of Acute Internal Medicine, the Certificate of Completion of Training (CCT) is awarded at an earlier stage than for training in other medical subspecialties and many of them, e.g. Respiratory Medicine, normally involve accreditation in both Acute Internal Medicine and the specialty. There are curricula which set three competency levels for Acute Internal Medicine. Details of these can be downloaded from the JRCPTB website.

Level 1 is achieved during completion of Core Medical Training. The competency level for the Acute Internal Medicine component in dual accreditation is level 2. This level of competence is required for a consultant in a specialty e.g. Gastroenterology, who also participates in the acute take. For those training in Acute Internal Medicine alone and who aim to become consultant acute physicians in charge of a Medical Admissions Unit level 3 competency in Acute Internal Medicine is required.

Meet your Higher Specialist Training Trainee Representatives

Thank you for voting for your new Higher Specialist Training (HST) trainee representatives!

We are pleased welcome Dr Nigel Lane and Dr Helen Johnston to the role. Remember, their roles provide you with the opportunity to voice your views and opinions at the HST Committee meeting and the annual School of Medicine board meeting.

To all Severn higher speciality trainees in medicine:

Dear Colleagues,

Firstly we would like to introduce ourselves as your HST trainee representatives on the School of Medicine Board within Severn Postgraduate Medical Education and also thank you to all who voted for us.

We are Nigel Lane and Helen Johnston both Acute Internal Medical trainees working in Severn PGME.

We appreciate that within each of your specialities you may have a rep and we would be grateful if you could let us know who that is and their email addresses. Alternatively, if you do not have a rep within your speciality we would recommend that you meet and decide on one person that can then relay information or concerns to us. We will set up a meeting in due course with all speciality reps.

We have recently attended our first HST meeting at Severn PGME earlier this month with the Training Programme Directors and Heads of the School of Medicine and will feedback the outcomes of this meeting and any relevant information in due course.

We would also recommend that you register on the School of Medicine website (via Severn PGME website) as you will be able to find our contact details, information relevant to training and details of training days etc.

We have a joint email account if you need to contact us, it is: Please let us know of any questions or concerns regarding training matters and any queries you would like us to take to the board. We will try and deal with each matter as they arise.

We look forward to meeting you all at the training days in due course.

Kind regards,

Helen Johnston and Nigel Lane

About the Reps

Dr Nigel Lane - ST3 - Acute Medicine

I am a Bristol graduate and have worked in the South West, North West and Australia. Under MMC I did a year of ACCS Acute Medicine in ITU and Anaesthetics as a StR2 followed by 12 months of a mixed medical rotation. I was fortunate enough to meet Sir John Tooke and be on the local panel to give views on the MMC crisis at the time. This year I started an StR3 post in Acute Internal Medicine.

As a trainee representative I would bring my varied experience to the post. I have attended BMA meetings nationally and put forward ideas that have been taken to the ARM. I have been actively involved at many junior doctor meetings. These showed me that it is only with trainees acting together that changes can be made. During the next few years trainees will be faced with challenges; new curriculums and Knowledge Based Assessments as well as the current issues regarding EWTD and the quality of training. Training needs to be delivered to a high level to equip trainees to work as Consultants in the future. I am ready to listen to all trainees and represent them during these exciting and challenging times.

Dr Helen Johnston - ST3 - Acute Medicine

I trained in Edinburgh and moved to Bristol in 2005. I spent 3 years as a medical SHO in the BRI, including 6 months in Weston. I then moved to Bath for a year, initially as a geriatric registrar and then as a gastroenterology registrar. I am now an Acute Internal Medical ST3 at Southmead

I have been involved in medical education and helping to improve training, both locally and regionally. I set up a free course called ‘The top 20 medical emergencies’ in the simulation centre for all CMT trainees in Severn PGME. The first 2 courses were a great success.

For 2 years I was the Associate College Tutor at the BRI which involved me implementing a CMT teaching programme and organising PACES teaching. I was the medical SHO representative in meetings at the College and Severn PGME during MMC and sat on the BRI junior doctors committee.

I want to help ensure good quality training and that as a group we are well represented and listened to at a higher level. I came from an old system into a new system in a difficult time so know how the system works and who to contact. I am friendly and approachable so can hopefully offer good support and be able to provide a voice for any issues, for those of you who know me I am certainly not quiet!