Acute internal medicine (AIM) remains a relatively new medical specialty having only been formally recognised in 2009.
AIM physicians provide the initial assessment, investigation, diagnosis and management of patients who have an acute medical illness (generally within the first 72 hours of their hospital stay). This usually takes place on an AMU (Acute Medical Unit), but many patients can be cared for in ambulatory care, allowing them to be discharged the same day.
Since 2005 there have been significant changes in the way acute care is delivered and in the team that delivers it. The presence of Acute Physicians in hospitals with unscheduled care has been shown to reduce mortality risk and the length of stay while in hospital, without increasing readmission rates. AIM is a young specialty that is rapidly expanding and evolving to become a major player in the future provision of healthcare in the UK. The clinical leadership and management of a highly specialised multidisciplinary team providing unscheduled care is a vital skill of the Acute Physician.
Trainees on the Acute Medical Unit will be involved in acute admissions, ambulatory care, rapid access medical and follow-up clinics, and the care of inpatients that remain on the unit for their on-going diagnosis and treatment. Further rotations in Respiratory Medicine, Cardiology, Elderly Care, and Critical Care are designed to give trainees a wide range of specialty skills and knowledge.
Practical skills are also a key area for the Acute Physician as procedures are performed daily as part of the acute care of patients. This includes such skills as lumbar punctures, chest drains and ascetic drains, both in an AMU setting and as part of ambulatory care services. Trainees are given dedicated time and support to learn a specialist skill. This is required for the award of a CCT in acute internal medicine and represents a unique opportunity during higher specialty training where trainees have sessions set aside to explore an area of medicine which is of particular interest to them. The full list of recognised specialist skills is available on the Joint Royal Colleges Postgraduate Training Board (JRCPTB) website linked below. Previous trainees in Wales have trained in transthoracic echocardiography, ultrasound, intensive care, medical toxicology, the diploma in Neurology, stroke medicine, and medical education. We remain willing to accommodate new interests too.The Specialty Certificate Examination in acute medicine must also be passed during higher specialist training.
Wales currently has 12 training posts leading to a dual Certificate of Completion of Training (CCT) in Acute Internal Medicine and General Internal Medicine. The training programme is usually of five years duration (although some specialist skills such as intensive care and stroke medicine do increase the training time). One year is usually spent in North Wales whilst the remainder of the programme is presently based in South East Wales. There is an annual summer school where trainees and trainers spend a week together in one of the more scenic parts of Wales to focus on education.