Time-based requirements
This program ensures adequate time for you to gain the necessary learning experiences across a range of relevant rotations during the total training time of 3 years (36 months FTE).
Training rotations for trainees commencing training in 2018 onwards
- 24 months core training.
- 12 months non-core training.
Core training
Core – General Medicine: 12 months core
- six months in a general medical unit:
- General medicine registrar
- six months of general medicine related rotations:
- more time in a general medical unit
- Acute Medical Unit/MAPU
- Perioperative medicine
- Senior medical registrar – with at least 50% clinical time
- Chronic disease management/Hospital in the Home (HITH)
Core – Subspecialty: 12 months core
- two x six months core-other specialty rotations (i.e. not general medicine or general medicine-related specialty terms)
- High-acuity specialty inpatient units, example training settings include:
- Intensive care unit
- Cardiac care unit
- Specialty inpatient units, example training settings include:
- Cardiology
- Gastroenterology / Hepatology
- Geriatrics / Rehabilitation medicine
- Haematology
- Infectious diseases
- Nephrology
- Neurology / Stroke medicine
- Oncology
- Palliative Care
- Respiratory medicine / Sleep medicine
- Ambulatory care / predominantly consultation based units, example training settings include:
- Clinical pharmacology
- Community-based palliative medicine
- Endocrinology/diabetes
- Immunology/allergy
- Rheumatology
Core training must include one six-month term in a high-acuity role.
This might be an acute assessment unit in the General Medicine year, or Intensive Care Unit (ICU) or Coronary Care Unit (CCU) in the other specialty year.
Non-core training
12 months of non-core training is required. This is intended to be predominantly clinical 12 months. Up to only 6 months without significant clinical time (50%) may be approved e.g. research.
Training rotations for trainees who commenced training before 2018
- 24 months core training
- 12 months non-core training
Core Training
A minimum of 24 months FTE must be spent in accredited clinical training positions under supervision.
Rotations should be at least six months in duration. Four-month roles will be considered, providing they form a component of a full year’s continuous program (i.e. three four-month rotations).Terms of three months or less will not be approved for core training.
In rotations where trainees may be required to do nights as service provision (e.g. Clinical Lead, Nightlife, etc.), the total duration should not exceed a maximum of four weeks (i.e. total of two weeks on-service and two weeks off-service) per 6-month rotation to satisfy as a core training rotation. Significant consultant supervision must also be provided.
Part-time training will be dealt with under the Flexible Training Policy, and trainees are encouraged to apply for part-time rotations of at least six months duration, e.g. six months at 0.5 FTE, equivalent to three months. In addition, the overseeing committee will accept rotations equivalent to FTE training, i.e. six months at 0.5 FTE or four months at 0.75 FTE, as non-core training.
In New Zealand three-month rotations may be permitted. Some hospitals offer four-month rotations that are not part of a full year’s continuous program and trainees are permitted to apply for these rotations. Note that training sites with prospective trainees applying for Advanced Training may contact the overseeing committee to confirm the requirements of Advanced Training.
Of the required 24 months, in both Australia and New Zealand, trainees must obtain:
- six months experience in general medicine
- six months in acute (Group A)
- six months in Group B*, and
- either six months in Group C* or an additional six months in Group B* (in a subspecialty significantly different from the other Group B rotation).
*At least 75% of the core subspecialty B or C rotations must consist of work in that particular subspecialty.
Trainees are expected to obtain broad experience outside of general medicine type rotations. In general, only 12 months of core training will be allowed in generalist type roles. Therefore, after six months of core general medicine, only one six-month rotation of Acute Assessment Unit, perioperative medicine, obstetric medicine, or senior medical registrar will be accredited as core terms. Thereafter, terms in these areas will be deemed to be non-core training.
Rotations categorised as Group A, B or C have decreasing levels of acuity. Not all positions in the same medical specialty will qualify for the same status, as this will depend upon the actual work done and the level of acuity.
Each rotation will need to be prospectively approved, based on its description. The overseeing committee expects that local hospital supervisors will know into which category a position falls, based on experience with trainees who have undertaken the role in the past.
It is very important for trainees to fully and accurately describe the nature of the rotation in their Application for Prospective Approval of Advanced Training, so that they receive the appropriate classification.
General Medicine Advanced Training rotations
Suitable training rotations involve:
- a minimum of two supervised ward rounds per week
- the admission of acute patients, based on a roster (minimum of one-in-seven basis)
- attending inpatients as a lead doctor, daily
- retaining responsibility for these patients for the duration of care (with medical team)
- attending at least one general medicine outpatient clinic per week
- having a role in a multidisciplinary team.
Example training settings include:
- General medicine registrar
Rotations in some hospitals associated with an acute assessment ward still fit into the general medicine category.
Group A rotations
The purpose of these rotations is for the trainee to gain experience in the management of patients with acute, life-threatening physiological disturbance.
These rotations require the following:
- daily supervised ward rounds and/or consultant contact
- a level of autonomy
- the admission of acute patients with life-threatening diseases to one’s own team, based on a roster (in and after hours)
- possibly working within a roster requiring evening and night shifts
Example training settings include:
- Cardiology – coronary care unit
- Intensive care unit
- Acute medical unit
- Acute stroke unit (preferably with thrombolytic availability)
- Emergency medicine
Group B rotations
The aim of these rotations is to provide the trainee with experience in the management of inpatients throughout the course of acute illness, including the planning of patient discharge, aftercare and follow-up.
Ideally, these rotations should involve exposure to other medical specialties, or might include the provision of general and acute care medicine consultative services and other services within the faculty, such as surgery and obstetrics.
These rotations require the following:
- a minimum of two supervised ward rounds per week
- a focus on inpatients
- involvement in a team responsible for consultations with inpatients who are primarily managed by other teams/units
- a component in acute care, although not substantial
- a significant outpatient workload (minimum of two clinics per week)
Example training settings include:
- Cardiology – inpatient ward
- Gastroenterology/hepatology
- Haematology/medical oncology
- Geriatric medicine
- Inpatient rehabilitation medicine
- Neurology
- Nephrology
- Infectious diseases
Group C rotations
The focus of these rotations is to provide the trainee with experience in the longitudinal care of patients, focusing the care of patients with chronic or complex diseases. It is expected that such rotations provide some training/experience in resolving issues that are too complex to be easily managed in a primary care setting.
These rotations involve the following:
- predominantly outpatients or non-acute inpatient referrals
- responsibility for less than four acute inpatients at any one time
- the possibility of an inpatient workload made up of arranged admissions or in-hospital transfers
- the possibility of primarily conducting research or teaching activities
Example training settings include:
* Rotations must include a clinical component in the form of clinics and ambulatory care. Rotations with no patient contact would not be considered Core Group C training.
Non-core training
A maximum of 12 months of non-core training may be undertaken in clinical training in other disciplines. The overseeing committee will prospectively approve, on a case-by-case basis, only those rotations that fall under non-core training. Terms between one and three months duration will only be eligible for non-core training.
Night and relief rotations will not under any circumstances be considered towards 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 trainees may be required to do nights as service provision (e.g. Clinical Lead, Nightlife, etc.), the total duration should not exceed a maximum of 4 weeks (i.e. total of 2 weeks on-service and 2 weeks off-service) per 6-month rotation to satisfy as a core training rotation. Significant consultant supervision must also be provided.
Training time in Australia/New Zealand
At least 24 months of core training must be undertaken in Australia and/or New Zealand.
Dual training
Dual training in General and Acute Care Medicine and another training program must consist of at least four years of training (full-time equivalent).
It is strongly recommended that trainees plan their training as early as possible to map out the training requirements of both programs.
Trainees undertaking dual training should be aware that a maximum of six months of their specialty training will be counted as core training for General and Acute Care Medicine. For example:
- a trainee in Respiratory Medicine and Sleep Medicine can count one six-month term of Respiratory Medicine or Sleep Medicine towards core training in General and Acute Care Medicine, but not both terms.
- a trainee in Gastroenterology can count only one term of Gastroenterology or Hepatology as core General and Acute Care Medicine training, not both terms.
Where uncertainty exists, please contact your Education Officer early to clarify which training will be certified.