IMT guide

Programme Leadership

Dr Nizab PP serves as the Site Director for the IMT programme. He is an excellent clinician and experienced diabetologist, with a strong commitment to high-quality medical education, trainee development, and patient-centred care. Under his leadership, the programme maintains robust clinical supervision, structured feedback, and a supportive learning environment aligned with UK training standards. His team include

Clinical Supervisors: Provide immediate, encounter-based feedback

Educational Supervisors: Review feedback trends, ensure progression

Trainees: Reflect, act, and document learning

Programme overview

Internal Medicine Training (IMT) is a structured postgraduate programme governed by the General Medical Council (GMC) and delivered through the Joint Royal Colleges of Physicians Training Board (JRCPTB). The programme is outcomes-driven, focusing on Capabilities in Practice (CiPs), professional development planning using SMART Personal Development Plans (PDP), audit and quality improvement activity (QIP), multisource feedback (MSF), and structured feedback models that promote insight and growth. The programme emphasises workplace-based learning, reflective practice, and continuous assessment through an electronic portfolio. Training progress is monitored through structured Supervised Learning Events (SLEs) such as ACAT (Acute Care Assessment Tool) and OPCAT, along with Workplace-Based Assessments (WPBAs), including Direct Observation of Procedures (DOPs). Trainees are supported by Clinical Supervisors and Educational Supervisors, with formal progression reviewed annually through ARCP (Annual Review of Competency Progression).

Curriculum & Governance

• Curriculum set by GMC

• Training overseen by JRCPTB

• All learning is documented in an e-Portfolio

Assessments & Learning

• SLEs: ACAT (Acute Care), OPCAT (Outpatient Care)

• WPBAs: Direct Observation of Procedures (DOPs)

• Minimum 4 ACATs per year across different specialities

• IMT Stage 1 has 14 Capabilities in Practice (CiPs), split into:

  • • 6 “Generic CiPs” numbered 1–6

    • 8 “Speciality (clinical) CiPs” numbered 1–8

CiP (Capability in Practice) is a real-world job task that a trainee must be trusted to do safely with an appropriate level of supervision. IMT1: needs close oversight for high-risk situations. IMT2/3: increasing independence, especially in acute care

Supervision Structure

• Clinical Supervisor: day-to-day clinical oversight

• Educational Supervisor (ES): overall training progress, multiple trainees

• Educational Supervisor Report (ESR) submitted annually

Feedback & Reflection

• Multi-Source Feedback (MSF) and Multiple Consultant Reports (MCR)

• Structured feedback using recognised models

• Focus on insight, reflection, and professional growth

Progression & Development

• Assessment against Capabilities in Practice (CiPs)

• SMART Personal Development Plans (PDPs)

• Mandatory Audit & Quality Improvement Projects

• Formal review through ARCP (Annual Review of Competency Progression)

Assessment data is triangulated using SLEs, WPBAs, MSF, MCRs, and trainee reflection. Feedback is structured, developmental, and aimed at promoting insight rather than judgement. The governance model ensures patient safety, trainee support, and consistent national standards are maintained throughout training.

What IMT Expects From Trainees

IMT trainees are expected to demonstrate effective clinical prioritisation, safe and timely decision-making, reflective insight, and professional conduct, preparing them for independent registrar-level practice and progression to higher speciality training. Key expectations include:

• Engagement in Supervised Learning Events (SLEs) and Workplace-Based Assessments (WPBAs), including ACATs, OPCATs, and DOPs

• Maintenance of a reflective e-Portfolio documenting clinical experience, feedback, and learning outcomes

• Progression across Capabilities in Practice (CiPs)

• Completion of SMART Personal Development Plans (PDPs)

• Participation in Audit and Quality Improvement Projects (QIP)

• Engagement with structured feedback, multisource feedback (MSF), and consultant reports (MCR)

The Feedback (Pendleton Model)

Feedback is a development tool, not a judgement. It is expected to be two-way

The aim is insight and progression, not immediate solutions or criticism. It should be a planned, evidence-based discussion that supports reflection, identifies strengths and areas for development, and guides trainees toward measurable improvement in clinical practice. 

• Pre-defined framework (not ad-hoc opinions), 

• Behaviour-focused, not personality-focused, 

• Evidence-based (observed events, cases, behaviours), 

• Two-way dialogue, not a lecture, and 

• linked to improvement, not just reflection

Feedback is a process, not a comment. Focus on (Pendleton model);

Pendleton: trainee says what went well → trainer adds → trainee says what to improve → trainer adds.

1. What went well (trainee)

2. What went well (trainer)

3. What could be improved (trainee)

4. What could be improved (trainer)

Avoid;

• Vague statements (“good”, “average”, “needs improvement”)

• Delayed feedback

• Public or emotionally charged feedback

• Comparing trainees with each other

Other feedback techniques:

• BOOST: Balanced, Observed, Objective, Specific, Timely.

• Feed-forward: focuses on “next time do X” (future action), not blame.

Used in SLEs (ACAT, OPCAT), WPBAs (DOPs), Educational Supervisor meetings, MSF & MCR discussions, and ARCP preparation. Keep it balanced (what went well + what to improve), and end with clear, achievable next steps (convert feedback into SMART PDP objectives).

Mapping of the feedback process (The role is not to judge performance, but to shape safe, reflective, independent clinicians)

Clinical Encounter Observed

        ↓

Learning Objective Identified

        ↓

Trainee Self-Reflection

(What went well? What was difficult?)

        ↓

Trainer Feedback (Structured Model)

• Strengths (Observed, specific)

• Development areas (Observed, specific)

        ↓

Why It Matters

(Patient safety/efficiency/professionalism)

        ↓

Feed-Forward

(What to do next time)

        ↓

Action Point Agreed

(SMART, achievable)

        ↓

Documentation

(e-Portfolio → SLE / WPBA)

        ↓

Mapped to CiPs & PDP

        ↓

ARCP Evidence 

Failure to document structured feedback may negatively impact ARCP outcomes, regardless of clinical competence. Poor feedback = weak ARCP, even with good trainees. What “Good Feedback” Looks Like

• Based on observed behaviour

• Balanced and specific

• Timely and private

• Focused on improvement

Feedback documentation: Record in e-Portfolio, and Link to CiPs and PDPs.

CiPs

1. Clinical assessment, prioritisation, decision-making 

2. Acute care management, escalation, safety

3. Safe prescribing and therapeutics 

4. Diagnostic reasoning and investigation choice

5. Procedural skills (via DOP feedback)

6. Communication with patients and families

7. Handover, continuity of care

8. Teamworking and MDT interaction

9. Leadership, delegation, situational awareness

10. Patient safety, risk recognition

11. Quality improvement and audit engagement

12. Professional behaviour and ethics

13. Insight, reflection, response to feedback (often decides borderline ARCP outcomes!)

Course overview (Stage 1, IMT; IM1-IM3)

Year focus: 

1. IM1 = acute assessment/take 

2. IM2 = outpatient clinics focus 

3. IM3 = acute take + functioning as the medical registrar

Minimum clinical exposure expectation:

• Acute take (unselected emergency medical admissions) involvement (personally participating in the assessment); Each year ≥100 acute medical patients/year and ≥500 by the end of the programme. 

• Inpatients: ≥24 months working in inpatient-based posts (ward-based general medicine/speciality wards, not purely outpatient/ambulatory); This is to ensure you get solid experience in longitudinal inpatient care

• Clinics ≥80 across training (OP clinic sessions); Purpose: chronic disease management, diagnostic reasoning in less-acute settings, follow-up care, communication, safety-netting.

Capabilities in Practice (CiP)

• CiPs are “real work tasks” assessed by expert judgement

• There are 14 CiPs (6 generic + 8 speciality)

• CiPs emphasise: Patient-centred care + Professional behaviour

Feedback & Supervision

• It's a two-way dialogue; reflection + feedback together = deeper learning

• It should be supportive, constructive, and high-quality

• Every trainee will have a named clinical supervisor (CS) and educational supervisor (ES)

• Clinical supervisor (CS): oversees day-to-day clinical work and feeds into ES judgement

• Educational supervisor (ES): overall educational progress + planning + review, and makes the summative judgement on progression using all evidence

Trainee Expectations

• Patient safety first; don’t work beyond competence without supervision; 

• Plan WPBAs; actively seek feedback; self-reflect; agree on action plans

Glossary

• GMC (General Medical Council): UK medical regulator; sets standards for training.

• JRCPTB (Joint Royal Colleges of Physicians Training Board): runs physician speciality training on behalf of the colleges (curriculum delivery framework).

• IMT (Internal Medicine Training): Stage 1 training (IM1–IM3). Stage 2 is after IMT, during speciality training.

• e-Portfolio: the online record of evidence (assessments, reflections, clinics, procedures, QI, supervisor reports).

• ARCP (Annual Review of Competency Progression): yearly panel review of portfolio evidence to decide progression/outcome.

• Interim ARCP: mid-year check (local) to identify gaps early.

• ESR (Educational Supervisor Report): structured summary of progress written by ES for ARCP.

• ES (Educational Supervisor): oversees overall training progress, learning plan, and signs off on readiness; can supervise multiple trainees.

• CS (Clinical Supervisor): day-to-day supervision in the placement/rotation.

• SLE (Supervised Learning Event): supervised “learning + feedback” assessments (not just scoring).

• WPBA (Workplace-Based Assessment): umbrella term for assessments done in real clinical work (includes SLEs and procedure observations).  It includes SLE (it's feedback-driven), ACAT, OPCAT, & DOPS

• SLE tools

  • • ACAT (Acute Care Assessment Tool): assessment of acute take work (often sampled as multiple cases).

    • OPCAT (Outpatient Care Assessment Tool): assessment of outpatient clinic work.

    • DOPS (Direct Observation of Procedural Skills): supervisor watches a procedure and gives structured feedback.

• Feedback tools

  • • MSF (Multi-Source Feedback): “360° feedback” from a group (consultants + nurses + peers, etc.); aims to capture behaviours/professionalism/teamwork.

    • MCR (Multiple Consultant Report): feedback reports from several consultants who’ve worked with the trainee.

• CiPs (Capabilities in Practice): “real-world job tasks” 

• PDP (Personal Development Plan): trainee’s goals + plan for improvement, reviewed with ES.

• SMART PDP: goals that are Specific, Measurable, Achievable, Realistic, Time-bound.

• Quality

  • • Audit: Compare practices to a standard

    • QIP / QI (Quality Improvement Project): improves a process/system (plan–do–study–act mindset). => improve a system  (change + re-measure)

Supervisor Role

1. Patient safety first: don’t let trainees operate beyond competence without supervision.

2. Create opportunities: acute take exposure, clinics, procedures, leadership moments.

3. Observe something real: feedback must be based on observed behaviour, not hearsay.

Structured feedback: every time there’s a meaningful clinical event:

• Strengths (specific)

• Development need (specific)

• Why it matters (safety/quality)

• Feed-forward (next time)

• Action plan (SMART)

What ARCP panels expect

1. Evidence quality => Specificity beats volume: fewer, high-quality assessments > many weak tick-boxes.

2. Triangulation: SLE/WPBA + reflections + MSF/MCR + outcome

3. Map evidence to capabilities (CiPs) and record progression trends.

Monthly ePortfolio checklist

1. Clinical exposure log 

• Acute: log a few representative acute cases (sick + not-sick mix)

• Decision points: escalation, discharge decisions, antibiotic choice, fluids/pressors, capacity/safeguarding

• Procedures: record any observed/assisted/performed procedures

Template to paste into portfolio

Case title: “ED sepsis – hypotension”

My role: clerked/reviewed/led/escalated

Key decision: antibiotics within ___ min; senior call at ___

Learning: “Recognise shock early; treat before full diagnosis”

Next step: “Use trigger for escalation: SBP<90 + suspected infection”

2. Assessments

   1. 1. SLE/WPBA per month as a baseline habit (more in acute rotations)

Mix: ACAT/OPCAT + DOPS (when procedures happen)

2. 1. 2. Always add: reflection + feed-forward + action

3. Clinics / ambulatory

Log clinic attendance with: supervisor, patient mix, 1 learning point, 1 follow-up action

4. Feedback evidence

Save: one “good feedback” entry monthly (even a short structured one) 

any significant event feedback (good or bad) with action plan

5. Quality improvement

QI project status updated monthly: aim → measure → change → result (even if early stage)

6. Teaching/learning

1 teaching session attended or delivered (can be micro-teaching)

1 CPD/reflection entry (short and relevant)

7.  Professionalism/governance

Any complaints/compliments, incident reflections, duty of candour learning, safeguarding/capacity cases (when relevant)

8. Supervisor touchpoints

Note dates of ES/CS discussions + what changed in PDP

CPD = Continuing Professional Development. => It’s the ongoing learning you do to stay competent and improve (courses, teaching, conferences, e-learning, journal reading, simulation, reflective learning from cases, audits/QI, etc.)