Role Of An Acute Internal Medicine (AIM) Doctor
An acute internal medicine (AIM) doctor provides care for patients with conditions characterised by rapid onset, severe symptoms, of life-threatening nature. They assess, investigate, and diagnose these conditions and treat the patients for up to 72 hours after their admission to the hospital, after which the patient is either allowed to return home or referred to another specialist.(1) AIM doctors jobs may also include managing outpatients in ambulatory care or in outpatient clinics.(1)
AIM doctors are presented with a wide spectrum of conditions every day and treat patients of all ages, and thus need to be skilled in a wide range of procedures and have sound knowledge and understanding of all medical specialties.(1)
Some of the common interventions performed in AIM are lumbar punctures, pleural aspiration, and paracentesis. AIM is a hands-on specialty, as critically ill patients often require urgent intervention.(1) A key part of working in AIM is determining the next step after acute care, whether the patient should be admitted to another specialty or whether they can be discharged immediately.(1)
There are opportunities for other careers than just a clinician in AIM. Trainees have the option to train and later perhaps work in the academia, and consultants may choose to work in teaching and management positions, such as clinical lead for a department, or clinical director for an NHS trust.(1)
AIM is a young, but fast expanding, specialty. It was previously a subspecialty of general internal medicine (GIM), until 2009.(2) Its necessity was, and occasionally still is, debated by some medical professionals. Yet nowadays it is becoming more and more apparent that having doctors trained specifically in the assessment, diagnosis, and management of acute cases helps provide better acute care for patients.
Previously GIM doctors had to carry out these tasks, despite lacking extensive acute-case focused training, potentially resulting in less effective patient care.(2)
AIM remains a predominantly male specialty, with ~65% of physicians in this specialty being male, but hopefully this will be changing as more women go on to study medicine.(3)
A Typical Week:
Since AIM doctors work with a broad spectrum of patients and conditions, the working day in AIM varies.(4) AIM physicians work predominantly in the acute medical unit (AMU) but they might occasionally see some patients in other inpatient wards as well as in the emergency department or ambulatory care units.(4)
Within the AMU, the doctors will be assessing and monitoring the treatment of the existing patients, alongside admitting and reviewing new patients.(4) Some administrative work needs to be carried out each day, and some physicians may have other activities such as teaching at a university or assisting in specialty training, management tasks, taking part in research or clinical audit, and others.(4)
The AMU operates 24/7, every day of the year, therefore the AMU staff works in shifts, ensuring sufficient and constant coverage of the ward. Over 80% of AIM consultants are routinely on call on the weekends.(4)
An AIM doctors will work with specialist nurses, A&E critical care staff, surgical teams, other healthcare professionals such as physiotherapists, administrative staff, and more depending on the conditions they are presented with.(4)
Becoming An AIM Doctor:
To apply for a training programme in AIM, applicants must have completed an MBBS degree or equivalent. To enter specialty training in acute internal medicine, trainees will need to have completed either core medical training (CMT) or acute common care stem - acute medicine (ACCS-AM). (5)
The CMT programme includes 4-6 placements in various medical specialties over two years, which must include direct involvement in acute medicine.(6)
ACCS is a 3-year programme consisting of six months placements in acute internal medicine, emergency medicine, anaesthetics, and critical care within the first two years. Provided that they have completed six months in each of the specialties, trainees may pick their specialty for the final year of the ACCS programme.(6)
Trainees will be assessed continually throughout their training via their portfolio and formative assessments, as well as workplace-based assessment. All trainees wishing to apply for ST3 in AIM need to have passed the MRCP (UK) exam before the application.(6)
Entry into both core medical training, and specialty training in AIM are via competitive application. The competition ratio for CT1/ACCS in acute internal medicine was 1.43 applicants per post in 2019, and the competition ratio for ST3 entry in AIM was 1.96 applicants per post in 2018.(7,8)
Specialty training in AIM lasts a minimum of 4 years.(5) All trainees are required to develop a specialist skill in one of four categories: procedural skill (e.g., ECG), additional qualifications (eg, medical education), specialty interest (eg, intensive care), or research.(5) Within the programme, all trainees must complete placements in geriatric medicine, intensive care, respiratory medicine and cardiology, as well as training on acute medicine units and in ambulatory care.(6)
Trainees will be encouraged to gain experience in other medical specialties to explore further acute-presenting cases, ensuring the whole curriculum is covered.(6) Trainees should gain experience in stroke medicine, and in diagnosing, assessing, and managing infectious diseases and acute gastroenterological, renal and rheumatological conditions.(6)
A new curriculum for acute internal medicine training is currently being approved by the GMC and is set to come out in 2022, meaning some aspects of training may change in the near future.(5)
To acquire their CCT, trainees must pass their Specialty Certificate Examination (SCE), alongside workplace-based assessments, and other forms of evaluation.(6)
AIM physicians may develop an interest in a specific clinical procedure, such as ECG, work in prehospital setting or even subspecialise in stroke medicine.(6)
It is possible to obtain a dual CCT with another, most commonly with general internal medicine. This will prolong the training time by approximately one year, and trainees wanting to obtain a dual CCT need to apply to a programme specifically advertised as dual training.(6)
Medical students interested in working in AIM should engage with the specialty as much as possible via university societies, project topics and placements. They are also encouraged to get involved with the GMC and become student members of the BMA.(9)
Foundation trainees should keep their portfolios up to date and well supported with medical evidence. It is recommended that foundation doctors try and undertake management and teaching opportunities, take part in clinical audit, try and present/publish work related to AIM, and gain experience in AIM and other similar specialties through taster sessions and placements.(9)
Core and specialty trainees need to ensure they have a sound knowledge base in general internal medicine. Joining the Society for Acute Medicine might also be helpful throughout, and after, their training, and trainees should try and speak to consultants and conduct some research about what consultancy in AIM is like.
Undertaking research project, accepting management and teaching opportunities, and presenting or publishing projects will also facilitate the progression into consultancy.(9)
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2020 the salary bands range from £77,779 to £109,849. Salaries can be further enhanced with NHS excellence awards.
There is limited potential for private practice in this specialty.
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
Before applying for AIM training, students and foundation trainees should explore the specialty as much as possible. Similarly, core and specialty trainees should look for resources to keep up to date with the newest advancements in AIM.
There are plenty of useful resources for this, starting with websites of professional bodies such as GMC, BMA, Royal Colleges of Physicians, or Society for Acute Medicine.
Other resources can be found in journals, such as the British Medical Journal (BMJ), Acute Medical Journal etc. A career in acute internal medicine by Nick Smallwood and Nigel Lane, an article published in 2015 in the BMJ is a good resource for students and trainees considering a career and AIM, and there is a range of academic and clinical research articles available in different medical journals.
Other forms of resources are available, such as videos on YouTube, for example Specialty spotlight - acute internal medicine by the Royal College of Physicians, as well as a variety of textbooks.
Related Job Sources With BMJ Careers
Other Complete Guides By BMJ Careers
Acute internal medicine, NHS health careers, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/acute-internal-medicine (accessed Oct 2020)
David Oliver: In support of acute internal medicine, D Oliver, BMJ, published 15 Aug 2017, https://www.bmj.com/content/358/bmj.j3832 (accessed Oct 2020)
Data chart: men outnumber women three to one in some specialties, BMJ Careers, published 6 Oct 2018, https://www.bmj.com/bmj/section-pdf/985554?path=/bmj/363/8170/Careers.full.pdf (accessed Oct 2020)
Working life- acute internal medicine, NHS health careers, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/acute-internal-medicine/working-life (accessed Oct 2020)
Specialty training curriculum for acute internal medicine, JRCPTB, published Aug 2009, amended Aug 2012, https://www.jrcptb.org.uk/sites/default/files/2009%20AIM%20%28amendment%202012%29.pdf (accessed Oct 2020)
Acute internal medicine (AIM), Joint Royal Colleges of Physicians Training Board (JRCPTB), https://www.jrcptb.org.uk/specialities/acute-medicine (accessed Oct 2020)
Specialty recruitment competition ratios 2019, Health Education England, https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202019_1.pdf (accessed Oct 2020)
2018 competition ratios, Health Education England, https://specialtytraining.hee.nhs.uk/portals/1/Content/Resource%20Bank/Competition%20Ratio%27s/Competition%20Ratios%202018.pdf (accessed Oct 2020)
Training and development, NHS health careers, https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/acute-internal-medicine/training-and-development (accessed Oct 2020)