Trainees who commenced in 2018 onwards
The Advanced Training Program in General and Acute Care Medicine allows adequate time for you to gain the necessary learning experiences across a range of relevant rotations during your minimum 3-year (36 months) full-time equivalent (FTE) training period.
Training rotations
| Training rotation |
Time requirement |
| Core training |
24 months minimum |
| – Core general medicine |
6 months |
| – Core general medicine-related |
6 months |
– Core subspecialty
Rotations must be completed in 2 distinct subspecialties |
12 months |
| Non-core training |
12 months |
High acuity rotation
During Advanced Training, you’re required to complete a 6-month high acuity rotation. The rotation can be completed during either core or non-core training.
Australian trainees
High acuity refers to caring for a patient with significant physiological abnormalities requiring high level medical monitoring, treatment and support. A high acuity position is usually found in Acute Medical Units, Intensive Care Units, Coronary Care Units with interventional capacity and Acute Stroke Units with interventional capacity or equivalent.
A cardiology term can range from acute to subacute to chronic care depending on your primary responsibilities, which must be specified.
Other positions such as an acute emergency liaison role may also be considered for the high acuity rotation. You must provide a detailed description of the rotation to the Training Program Committee (TPC) – General & Acute Care Medicine for consideration.
Acute care of the elderly and geriatric roles are not considered as high acuity as the case mix that you’re exposed to doesn't allow you to adequately meet the requirement for a high acuity rotation for General and Acute Care Medicine training.
Aotearoa New Zealand trainees
The TPC considers the following 4 aspects when determining whether a general medicine or acute assessment role can be considered high-acuity. A rotation is expected to include at least 3 of these aspects on a regular basis in normal working hours.
- Direct involvement in and supervision of non-invasive ventilation.
- Direct involvement in the administration of thrombolysis, such as cardiac, pulmonary embolism or stroke, and subsequent inpatient care of these patients.
- Regular first-responder to medical emergency and cardiac arrest calls.
- Maintenance of primary team responsibility for care of ICU and/or High Dependency Unit level patients.
Not all cardiology and respiratory rotations are considered high-acuity as these rotations can range from acute to subacute to chronic care depending on your primary responsibilities. If undertaking a cardiology or respiratory rotation, you must specify your primary responsibilities on your prospective application form and approval will be considered by the TPC on a case-by-case basis.
Core training
A minimum of 24 months FTE must be spent in accredited clinical training positions under supervision.
In Australia, rotations should be at least 6 months in duration. 4-month roles will be considered. Rotations of 3 months FTE or less will not be approved for core training. A 6-month rotation undertaken at 0.5 FTE may be approved as 3 months core training if the pro-rated training duties and requirements are met.
In Aotearoa New Zealand, 3-month rotations may be permitted.
Core general medicine | 6 months FTE
Training in a general medicine unit as a general medicine registrar, where a suitable rotation involves:
- a minimum of 2 supervised ward rounds per week
- the admission of acute patients, based on a roster (minimum of 1-in-7 basis)
- attending inpatients as a lead doctor on a daily basis
- retaining responsibility for patients' longitudinal care where you must be involved throughout the patient's journey from inpatient admission, the duration of inpatient care to hospital discharge and subsequent review in clinic
- attending at least 1 general medicine outpatient clinic per week
- having a role in a multidisciplinary team
Aotearoa New Zealand trainees
- Rotations with rostered periods of time working in MAPU will only be approved if no more than 1/3 of overall run time is spent in MAPU. For example, if a run is 6 months long, a maximum of 2 months can be spent in a MAPU.
- Trainees who undertake a ‘Fellow role’ as part of their core general medicine training time must ensure they meet the requirements outlined in Appendix 1.
Core general medicine-related | 6 months FTE
Rotations in general medicine-related training can be allocated to:
- more time in a general medical unit
- an Acute Medical Unit and/or Medical Assessment and Planning Unit (MAPU)
- obstetric medicine and perioperative medicine
The following may be approved in Australia. There are no rotations in Aotearoa New Zealand that currently fall under these categories, but bespoke rotations may be considered on a case-by-case basis:
- a senior medical registrar position, with at least 50% clinical time
- chronic disease management/Hospital in the Home (HITH)
- residential outreach/Hospital Admission Risk Program (HARP)
General medicine-related training rotations exceeding 6 months can be approved for non-core training.
Core subspecialty | 12 months FTE
Your core subspecialty training must be comprised of 2 x 6-month core rotations completed in 2 distinct subspecialties, it can't be completed in general medicine or general medicine related specialty terms.
A subspecialty term must have more than 75% of time spent in clinical responsibilities in a subspecialty over 6 months to provide the depth of training required.
Specialty inpatient units in settings that include:
- cardiology
- gastroenterology, hepatology
- geriatric medicine, rehabilitation medicine
- haematology
- intensive care unit (ICU)
- infectious diseases
- nephrology
- neurology, stroke medicine*
- oncology
- palliative care
- respiratory medicine, sleep medicine
Ambulatory care and/or predominantly consultation-based units:
- cardiology – chronic disease management e.g. heart failure
- clinical pharmacology
- community-based palliative medicine
- endocrinology, diabetes
- immunology and allergy
- rheumatology
If you're undertaking a subspecialty term with less than 75% of time spent in one subspecialty, you'll be required to complete more than 6 months training in order to gain sufficient exposure.
Applications for subspecialty terms with less than 50% subspecialty time will be assessed the Training Program Committees on a case-by-case basis.
If you're a dual trainee, your core subspecialty training must be undertaken in an accredited clinical training position that has been accredited for General and Acute Care Medicine or in the second specialty that you're undertaking dual training in.
*Aotearoa New Zealand trainees
Stroke runs may be classified as geriatric medicine or neurology, depending on the service model provided by the setting. Trainees will be advised of their rotation status after their application for prospective approval has been submitted and considered by the TPC. For enquiries, contact generalmedicine@racp.org.nz
Non-core training
12 months FTE of non-core training is required.
This is intended to be predominantly clinical training. Up to 6 months only (50%) of training that’s not comprised of significant clinical time may be approved for activities such as research.
Aotearoa New Zealand trainees
During both core and non-core training rotations, trainees must dedicate one half-day per week to personal professional development and project work.
This must be clearly documented in a trainee’s prospective approval information.
View the site accreditation criteria (PDF) for general and acute care medicine.
Night rotations
Night and relief rotations will not count towards your Advanced Training in General and Acute Care Medicine, except in ICU or emergency medicine where nights are accepted as part of a shift roster.
In rotations where you may be required to do nights as service provision, the total duration should not exceed a maximum of 4 weeks on a night duty roster — for example, a total of 2 weeks on service and 2 weeks off-service per 6-month core rotation.
Core training supervision requirements apply.
Dual training
Dual Advanced Training in General and Acute Care Medicine and another training program must consist of at least 4 years FTE training.
It’s strongly recommended that you plan your training as early as possible to map out the training requirements of both programs.
If you’re undertaking dual training, be aware that your specialty training can count towards a maximum of 6 months core training and 12 months non-core training for General and Acute Care Medicine (maximum 18 months total training time). For example:
- a trainee in Respiratory Medicine and Sleep Medicine can count one 6-month term of Respiratory Medicine or Sleep Medicine towards core training in General and Acute Care Medicine, but not both terms. An additional 12 months of Respiratory Medicine and/or Sleep Medicine can count towards non-core training.
- a trainee in Gastroenterology can count only one 6-month term of Gastroenterology or Hepatology as core General and Acute Care Medicine training, not both terms. An additional 12 months of Gastroenterology and/or Hepatology can count towards non-core training
Training time
At least 24 months of Advanced Training in General and Acute Care Medicine must be undertaken in Australia and/or Aotearoa New Zealand. This is to ensure that you receive adequate exposure to local practices and health services.
Restrictions apply to the amount of leave that may be taken during training. Provisions regarding absence during training are outlined in item 4.5 of the Progression Through Training Policy.
Appendix 1
Fellow role requirements - Aotearoa New Zealand trainees
- trainee must have completed 6 months core General Medicine prior to this run
- trainee must have completed 24 months of Advanced Training in General and Acute Care Medicine
- ideally, the high acuity requirement should have already been met
- Advanced Training Research Project should be underway/completed
- administration or project time should be included in the timetable
- supervised weekly post-acute ward rounds for the first month and then reduced to once a month in timetable
- weekly paper rounds and peer review of difficult cases must be available
- senior medical officer (SMO) back-up required when on call, including shadow call for out of hours acute duties (overnight and weekends)