Training & Certification FAQs
Training and certification
Dual accreditation in GUM and IM will allow CCT holders the flexibility of applying for consultant posts in GUM, HIV, SRH and IM, to include participation in both specialty and acute take. Depending on experience, posts may also include academia, clinical trials, SARCs, Prison HIV and sexual healthcare, genital dermatology, women’s health, complex contraception, hepatology and public health. HIV outpatient services are currently not commissioned to provide general medical care to patients. This may change in the future as dually accredited doctors complete CCT and as our ageing HIV cohort develop an increasing number of medical comorbidities.
Current GUM consultants will be able to lead integrated services or work within acute trusts, providing GUM, SRH and HIV care. Depending on their expertise they may also be able to work in academia, clinical trials, sexual assault referral centres (SARCs) and in services providing Prison HIV and sexual healthcare, genital dermatology, women’s health, complex contraception, hepatology and public health. They will not be able to participate in the acute unselected medical take.
Public health England data suggests that several STIs, including Chlamydia, Herpes, Shigella, Syphilis (STS) and Gonorrhoea (GC), are increasing, with rates of STS & GC increasing by 165% and 250% over the last 10 years. Funding cuts and reduced access to sexual health services are therefore likely to have severe adverse effects on the Nation’s sexual health. The BASHH/THT ‘State of the Nation’ report published in February 2020, highlights the emerging crisis in STIs in England. BASHH continue to lobby with the government to prioritise funding for sexual health services, in addition to working on a new National strategy for sexual health and reproductive health, which was agreed by the government in the autumn of 2019. GUM physicians remain key in leading services which diagnose, treat and manage people with STIs, including HIV, making a career in GUM all the more rewarding at this critical time.
In 2018 and 2019 the number of consultant posts advertised exceeded number of CCTs (2018: 18 CCTs vs.38 substantive (26 FT, 12 PT) and 18 locum consultant posts; 2019: 19 CCTs vs. 32 substantive posts (18 FT, 14 PT) and 20 locum consultant posts. Of the substantive posts, two were advertised as HIV only, the remainder a mix of ISH/HIV, GUM/HIV and SH/HIV. One of these posts in Scotland and 31 in England, of which 1/3rd were in Greater London.
There are 140 National GUM NTNs across England, Scotland, Wales and Northern Ireland over a wide range of units of application, so you should not be limited in your choice of location. 42% of GUM NTNs are based in London. In 2019, two regions filled all available vacancies (Scotland and KSS, n=4). There were 46 posts available across 13 LETBs/Deaneries. 20/46 (43%) vacancies were based in London/KSS (46% in 2018); 6/20 (30%) of these were filled (41% in 2018, 92% in 2017) compared to 6/26 (23%) (25% in 2018) posts outside London; seven regions did not fill any of their available vacancies (Wessex, Wales, North East , North West, East of England, Thames Valley and South West Peninsula)
There are approximately 140 NTNs in the UK (42% in London), some of which have two trainees job sharing, of which 34 are not filled by specialty trainees. The JRCPTB State of Physicianly Recruitment report 2019 stated that GUM continues to have a low fill rate of 26% in 2019 (only 12 out of 46 vacant posts were filled in contrast to a fill rate of 59% in 2015 and 100% in 2013) and it appears that posts outside of London are harder to fill. This is mainly due to fragmentation of services due to split GUM/HIV commissioning, on-going reduction in funding to services from local authorities and uncertainties due to tendering. There are few actual vacancies as empty NTNs are often filled by specialty /trust grade/FY3/LAS doctors on a fixed term contract.
Yes. Previous experience is desirable but not essential. Apply for national and/or local tasters, do a relevant course-online/in person to increase your understanding of the specialty and ask your local service if you can help complete an audit or quality improvement project relating to GUM or HIV.
GUM is a physicianly specialty with a four year training programme, starting from ST4 (from 2022), which requires three years of IM stage 1 training and full MRCP(UK) for entry. By CCT trainees will be expected to have achieved the Dip GUM and Dip HIV. cSRH is a six year run through programme, starting at ST1, which trainees can apply for after completion of the second year Foundation Programme. CCT holders are expected to have passed the membership of the faculty of sexual and reproductive health (MFSRH) exam. The cSRH curriculum covers screening and management of non-complex STIs and offers training in all aspects of complex contraception and community gynaecology, including Termination of Pregnancy (TOP). GUM focusses on all aspects of complex STI and HIV care including training in non-complex contraception. Further details of current curricula can be found at www.fsrh.org.
DFSRH, LoC sub dermal implant (SDI) and IUD/IUS insertion, assessed by LoC IUT, will not be mandatory in the new curriculum but recommended if trainees wish to undertake them. Trainees will be expected to manage non-complex contraception presentations in out-patient or community settings as part of integrated sexual health services. Trainees wishing to gain competencies in more complex contraception, women’s health and scanning can apply to do this as an out of programme experience (OOPE) and each application will be assessed on a case by case basis by the local GUM training programme director. This training will not be a mandatory part of the new curriculum.
GUM trainees will be expected to pass two knowledge based exams: the Diploma in Genitourinary medicine (Dip GUM) and the Diploma in HIV Medicine (Dip HIV), before they are awarded a CCT in GUM and IM under the new curriculum. The Diploma of the faculty of sexual and reproductive health (DFSRH) is recommended but will no longer be compulsory. There will be no exit exams.
Under current GMC regulations, trainees on the old curriculum will have to transfer to the new curriculum within two years of implementation, unless they are in their final year of training when the new curriculum goes live. However, if they do wish to switch to the new curriculum transition arrangements will be possible and will need to take account of the trainee’s stage of training and be cognisant of local service and training needs. We recommend that as trainees who will still be in programme after August 2024 are likely to need to transfer to dual training, it is advisable to maintain internal medicine capabilities acquired in CMT/ACCS-AM, if there is opportunity to do so. A detailed implementation plan for trainees during the transition period is yet to be finalised with the GMC and as soon as there are more details, these will be communicated.
- completion of a Certificate of Completion of Training (CCT) in GUM and then starting another specialty programme, incorporating dual training with GIM, to gain outstanding competencies and claim credit for competencies already attained, or vice versa.
- OR current trainees can seek to show equivalence to obtaining a GIM CCT via the Certificate of Eligibility for Specialist Registration (CESR) route. This involves further training in GIM and recognition of competencies already achieved. A mapping document has been produced to help with this.
The first entrants to the new IM stage 1 training were in August 2019, therefore the first cohort to complete three years of IM stage 1 and enter specialty ST4 training programmes will be in August 2022. The first cohort of GUM trainees to complete the four year training programme from ST4-7 and to dually accredit in both GUM and IM will be in August 2026. There will be no opt-out to drop either GUM or IM and obtain single accreditation although it should be easier to switch from one dually accredited specialty to another.
Yes. Although numbers of HIV in-patients are falling it is important that all those caring for HIV patients are able to assess when a patient needs referral for admission and to understand how HIV related conditions and AIDS defining illnesses are managed. We anticipate that the minimum time spent training in managing HIV in-patients will continue to be three months with some centres opting to provide their trainees with six months or more of in-patient exposure.
An indicative 12 months of IM training is required in the new curriculum. This will be integrated flexibly within the specialty training programme although it is likely that at least three months of IM will need to be completed in the final year of training. Some GUM programmes will choose to run this as a separate year whilst others will integrate it within the specialty training. It is expected that some HIV in-patient and outpatient experience can count towards IM training. GUM and IM stage 2 training will most likely include supporting the acute specialty take in addition to the acute unselected take.
Genitourinary medicine is a group 1 specialty and will be entered following selection at ST4, on completion of three years of Internal Medicine (IM) stage 1 or Acute Care Common Stem – Acute Medicine/Internal Medicine (ACCS-AM/ACCS-IM) with full MRCP(UK). Trainees who have sat MRCP PACES, where the outcome is not yet confirmed, can apply and receive a proleptic offer (one which they can only take up if they pass the MRCP(UK) examination). A trainee would then dual train with the GUM and IM stage 2 curricula for four years before achieving a dual CCT in GUM and IM
a) Dual accreditation with Internal Medicine (IM)
b) The use of CiPs to help doctors to better understand what is expected of them in their training programme to enable reliable, holistic decisions to be made about their suitability to progress. The large number of detailed competencies in the 2016 curriculum will be replaced by the eight specialty CiPs below:
- Managing patients with non-complex GUM health presentations in out-patient or community settings
- Managing patients with complex GUM/contraception presentations in a specialist out-patient or community setting
- Providing specialist care for individuals living with HIV in an out-patient or community setting
- Providing specialist care for individuals with diagnosed HIV/AIDS in a hospital in-patient setting
- Delivering interventions to prevent transmission of HIV, other BBVs and STIs
- Supporting early detection of STIs and HIV in all settings
- Safeguarding of public health and delivering sexual health/HIV services and information for specific populations in a range of settings
- Ability to successfully lead, manage and work with specialist service commissioning in acute and community settings
c) Updated public health and epidemiology section
d) Requirement for punch biopsy procedural skill to be recommended rather than mandatory
e) Obtaining the DFSRH and letters of competence in intrauterine techniques (LoC IUT) and subdermal contraceptive implants (SDI) to become recommended not mandatory requirements
The 2016 updated curriculum offers training in: investigation, diagnosis and management of acute and chronic sexually transmitted infections (STIs) and blood-bourne viruses (BBVs) ie HIV and Hepatitis, in cis and trans men and women including non-binary individuals, contraception, HIV in-patient, out-patient and on-call management including management of HIV in pregnancy, adolescents, hepatitis co-infection, TB co-infection, Antiretroviral Therapy (ART), psycho-social aspects and sexual and reproductive health in HIV. In addition, it offers training in managing sexual health in specific groups such as men who have sex with men (MSM), children, young people and prisoners. There is also training in Obstetrics & Gynaecology, Dermatology, epidemiology and public health competencies relevant to GUM, sexual dysfunction, sexual assault, pre- and post- exposure prophylaxis for HIV, research methods, teaching, management and leadership skills.
The Shape of Training (SoT) review was launched in 2012. It’s report was published in October 2013 and recommended a reform of postgraduate training of all doctors to ensure it is more patient focused, more general (especially in the early years) and has more flexibility of career structure. This fits with HIV being a chronic, treatable condition with an increasing burden of medical comorbidities in an ageing cohort. A further driver for change was the GMC review of the curricula and assessment standards, which led to the GMC’s report ‘Excellence by design: standards for postgraduate curricula’ in May 2017’. It concluded that all new postgraduate curricula should be revised from 2020 and that the large number of detailed curriculum competencies should be replaced by fewer higher level learning outcomes known as capabilities in practice (CiPs). Curricula must also incorporate Generic Professional Capabilities (GPCs) to ensure that the patient is at the centre of any consultation and decision making.
Yes, patients who are a part of the acute unselected medical take (for example, patients with IECOPD or OOH cardiac arrest) can count towards the requirement to see 750 patients overall presenting with acute medical problems: https://www.ficm.ac.uk/dual-triple-ccts
The FICM & JRCPTB would support a doctor in training, who was part of the ICU outreach role covering medical wards and admissions, counting this towards the GIM requirements of HILLO 1 of the Internal Medicine CiPs. However, time also needs to be undertaken as the medical specialty registrar leading/overseeing the medical take to fully achieve this capability. This includes experience in the final year of training.
ICU follow-up clinics can count towards some of the GIM clinic requirement but not all:
https://www.ficm.ac.uk/dual-triple-ccts. To fulfil the clinic requirement for GIM there must be some experience of medical specialty or GIM clinics.
Yes. Some experience in ICM can count towards GIM outcomes where it is relevant. Examples can include looking after patients with GIM related illnesses on ICU, end of life care and reviews on the wards and in emergency departments. https://www.ficm.ac.uk/dual-triple-ccts
All curricula are now outcome based, as per the GMC’s Excellence by Design standards & requirements. Therefore, extensions to training time should only occur if you are deemed not to have met the outcomes. This includes the necessity to ensure all capabilities are current and that there is adequacy of experiential learning.
No, the requirement is to complete 2 years (and a further 3 months in AIM/Renal) of the medical specialty in Stages 1 and 2. For those who join ICM training at the end of ST5, this will already have been completed. There remains the need to obtain some GIM training in the last year as above to ensure that GIM capabilities are current. Medicine placements should be limited to the required levels after the main experience has been obtained to ensure ICM Stage 1 & 2 capabilities are also achieved. The later an Intensivist in Training (IiT) commences triple CCT training, the likelihood of the minimum described period of training will be lengthened, as there will have been less time to dual/triple count capabilities. If anyone has any queries regarding this, please contact the Faculty for advice via: contact@ficm.ac.uk
No, Stage 3 can be completed in any order although GIM on calls must be completed within the final 12 months of training leading up to your CCT to maintain capability. If your final year of training is a 12 month ICM placement, contemporaneous acquisition and maintenance of GIM capabilities can be achieved by 'release' from ICM for GIM sessions on an ad hoc locally agreed basis, and via applicable practise and experience in ICM/other environments
Yes, where teaching is relevant to both ICM and GIM, it can count towards both specialty teaching hours.
The Palliative Medicine Specialist Advisory Committee have produced guidance on the training methods for achieving competencies in palliative and end of life care for trainees in non palliative training posts and programmes.
The Young Adult & Adolescent Steering Group at the Royal College of Physicians London has developed guidance for JRCPTB on how the required competences and experience can be gained in young adolescent and young adult health care. This guidance is aimed at trainees, trainers and programme directors.
It should take place 12-18 months prior to your expected training completion date and your progress so far will be reviewed against your curriculum. This period IS NOT pro rata for Less Than Full Time Trainees who will also be required to undergo their PYA 12-18 months prior to completion, regardless of the number of sessions worked per week. The PYA will then identify outstanding targets to ensure the requirements of the curriculum are met in full.
If for any reason the final CCT date is more than 24 months after PYA then you must have a second PYA and it must be in line with the current curriculum.
The National Inter Deanery Transfer (IDT) process has been put in place to support medical trainees who have had an unforeseen and significant change in circumstances since commencement of their current training programme and need to move from one region to another.
The process is managed by the National IDT team (Health Education South London) on behalf of the Conference of Postgraduate Medical Deans (COPMeD), Health Education England (HEE) and all UK regions. If you are planning to apply for an IDT process please visit the HEE website for guidance.
We have produced guidance on acting up for Core Medical Trainees. Schools of Medicine may choose to adapt this for use locally.
The Royal College of Physicians London and Royal College of Physicians of Edinburgh Medical Training Initiatives enable international medical graduates to undertake a two year sponsored training fellowship in the UK.
Access for RCP London International Medical Graduate (IMG) doctors
International medical graduates (IMGs) taking part in the RCP London Medical Training Initiative are eligible to use the JRCPTB ePortfolio for up to two years. IMGs are asked to request access by contacting the RCP International office at mti@rcplondon.ac.uk.
Access for RCP Edinburgh International Medical Graduate (IMG) doctors
International Medical Graduate doctors seeking short-term training in the UK are eligible to use the ePortfolio for up to two years. To get access to the ePortfolio you must be registered on the RCPE IMG Scheme and be approved by the Royal College of Physicians of Edinburgh IMG team. For further information on the IMG Scheme contact Shona McGlynn or visit the RCPE website.
For permanent posts, direct applications for internal medicine training (IMT) and specialty training posts can be made through the recruitment websites, where guidance is available on demonstrating appropriate competencies and eligibility.
The General Medical Council (GMC) will make a decision on granting you a licence to practice (equivalent to entry of Foundation Year 2) to enable you to take up an appointment in the UK. For more information on this, please visit the GMC website.
Specialist registration/completing training
We have issued guidance for Specialist Advisory Committees on the process for recommending an earlier CCT date for trainees acquiring competencies more rapidly than anticipated. This guidance should apply to all medical specialties supervised by JRCPTB but may be subject to variation depending on subsequent GMC advice.
This is because either:
- Your actual scheduled date of completion of training is today
or
- There has been a delay in your completion and the GMC have entered you on to the specialist register at the point which they finalised the recommendation
Please note; JRCPTB cannot alter this final date.
As per the Gold Guide Section 6.34, dual training completion dates must be the same. There is no provision for identifying different dates for completion of training.
You can be interviewed for consultant positions six months prior to your completion date. This is referenced in latest version of the Gold Guide.
- Service posts - eg Locum Appointments for Service (LAS)
- Clinical Fellow, Honorary or Trust posts that do not either carry GMC approval or form part of an Out of Programme Episode whilst in a numbered post - see the OOP page
- All substantive numbered posts that make up a trainee's NTN.
- Locum Appointment of Training (LAT) posts
- Any post that carries GMC approval
Out of programme
Initially you will need to advise the deanery/HEE local office and JRCPTB of the date you intend to commence parental leave. On your return to clinical training you will need to fill out the completion date calculator with your date of return and if this will be on a full-time or less than full time basis and send to your deanery/HEE local office.
If you want time out of programme (OOP) to count towards the award of a CCT or a CESR via the Combined Programme (CESR CP), the GMC must approve the post before it starts.
It is therefore essential that your request for training credit is submitted to JRCPTB for consideration at least 8 weeks prior to the start date. All OOP applications that request training credit must have approval by the relevant JRCPTB Specialist Advisory Committee (SAC) before the GMC can approve the post. Applications for OOP training credit that are submitted to us with less than 8 weeks notice will not be considered for training credit.
The application form is available on our website. See the Out of programme page for further information.
Although it is possible if supported by the deanery/HEE local office, it is strongly recommended by the JRCPTB that trainees do not undertake any OOP episodes in their final year of training. In any event, a PYA must be undertaken first for each of your specialties and it is unlikely that credit towards training will be granted in full for OOP episodes in the final year of training.
Penultimate year assessment
Penultimate Year Reviews have replaced Penultimate Year Assessments for those on a 2021 or later specialty curriculum. The Penultimate Year Review will be undertaken by one of the following:
- Trainee's Educational Supervisor or
- Trainee's Training Programme Director or
- External Advisor
The Penultimate Year Review will review the trainee's specialty training undertaken to date and agree the specialty curricula requirements that remain outstanding to complete training. The outstanding requirements will be listed in the Penultimate Year Review as Mandatory targets and documented on the trainee's eportfolio. Recommendaed (non-mandatory) targets may also be listed. All mandatory targets must be listed and noted as "ACHIEVED" in the ARCP outcome 6. PYR forms are currently in development and should be available soon on eportfolio for each higher medical specialty. In the meantime, it is recommended that ARCP Interim Review or Educational Meeting forms are used to record the PYR on eportfolio.
If you are performing the role of External Advisor and conducting penultimate year assessments (PYAs) on behalf of JRCPTB then you may submit claims for travel expenses if the host deanery is not holding ARCPs on the same day. In most circumstances, the deanery will host combined ARCPs and PYAs on the same day. In these cases, expense claims should be submitted to the host deanery.
If you have any questions please contact the training programme support team at pya@jrcptb.org.uk.
It should take place 12-18 months prior to your expected training completion date and your progress so far will be reviewed against your curriculum. This period IS NOT pro rata for Less Than Full Time Trainees who will also be required to undergo their PYA 12-18 months prior to completion, regardless of the number of sessions worked per week. The PYA will then identify outstanding targets to ensure the requirements of the curriculum are met in full.
If for any reason the final CCT date is more than 24 months after PYA then you must have a second PYA and it must be in line with the current curriculum.
To ensure you benefit the most from the PYA, you must ensure the following is completed at least four weeks before the PYA event.
- Set up a new folder within your personal library on the ePortfolio called '(Specialty) PYA paperwork'
- Ensure that the summarry of clinical experience (SOCE) form is completed and uploaded to the above folder.
- Ensure that an up to date CV is uploaded to the above folder.
- Ensure that your ePortfolio is up to date so that the assessor has the ability to check your progress to date.
- The assessor will complete an electronic PYA form which is located within the 'PYA' tab on your ePortfolio. Check this tab to ensure that the relevant PYA form is available.
The PYA exists to ensure that trainees are meeting the standards set by the curriculum through a meeting between the trainee and those responsible for writing the curriculum. It allows trainees to review their own progress with a representative of their specialty who is external from the local deanery and discuss their development against the entirety of the curriculum. It is also an opportunity to discuss future opportunities both for remaining training periods and with a view on post-training work.
The differences are subtle but significant:
ARCP | PYA |
Reviews trainee progress against that year | Reviews trainee progress within whole programme |
Compares regional/ home trainees data per year | Compares national information across regions and years |
Can be done without the trainee present | Cannot be done without the trainee present |
Cannot review its own programme within the GMC requirements for quality assurance of training | Can provide enough data to review programmes in line with GMC quality assurance requirements |
Reviews trainee competency | Reviews trainee confidence - provides trainee an opportunity to seek non-deanery opinion |
LAT/LTFT
It should take place 12-18 months prior to your expected training completion date and your progress so far will be reviewed against your curriculum. This period IS NOT pro rata for Less Than Full Time Trainees who will also be required to undergo their PYA 12-18 months prior to completion, regardless of the number of sessions worked per week. The PYA will then identify outstanding targets to ensure the requirements of the curriculum are met in full.
If for any reason the final CCT date is more than 24 months after PYA then you must have a second PYA and it must be in line with the current curriculum.
On appointment to a specialty post with a national training number you must inform your Educational Supervisor that you wish to seek credit for a LAT. Your application will be reviewed by your Training Programme Director and Educational Supervisor in accordance with the JRCPTB LAT policy.
Other training issues
Please see our transition guidance page for information and the rough guide for the relevant specialty.
The Young Adult & Adolescent Steering Group at the Royal College of Physicians London has developed guidance for JRCPTB on how the required competences and experience can be gained in young adolescent and young adult health care. This guidance is aimed at trainees, trainers and programme directors.
The Palliative Medicine Specialist Advisory Committee have produced guidance on the training methods for achieving competencies in palliative and end of life care for trainees in non palliative training posts and programmes.
For verification of your training, please contact the GMC directly or visit their website here.
As identified in the Certification section, this will depend on your current situation.
- If you have an NTN with a C suffix, you are deemed to be training towards a CCT and all training will have been in UK approved posts. If you wish to count previous experience that is not from UK approved posts towards your training, you will no longer be eligible for a CCT and must train towards a CESR CP. This must be arranged in consultation with your Training Programme Director and you will need to have your NTN amended to reflect that you are now training as a CESR(CP). Any previous experience or credit must be granted before your first ARCP.
- If you have an NTN with an L suffix, you are deemed to be training towards a Combined Programme CESR (CESR(CP)). Any previous experience or training not already considered for counting towards the CESR CP must be submitted to your deanery, at the earliest opportunity and noted at the first specialty training ARCP (ie ST3 ARCP). From this point, the deanery may make a recommendation for additional competencies against your curriculum to be considered by the JRCPTB. This should be done through your Training Programme Director in the first instance.
About JRCPTB
The Federation of Royal Colleges of Physicians will pay car mileage at a rate of 45p per mile. However, where a car is used for convenience on long journeys instead of public transport, we will pay only the cost of public transport for the same journey. You can claim this online here under 'Federation General Expense'. Full guidance can be found here. Please note, this is an an interim arrangement while a new policy is being developed and agreed.