Intended for healthcare professionals


Core medical training: a survival guide

BMJ 2016; 354 doi: (Published 14 September 2016) Cite this as: BMJ 2016;354:i4376
  1. Natalie King, core medical trainee year 2,
  2. Ramabhadran Balaji, consultant rheumatologist
  1. Luton and Dunstable University Hospital
  1. nyking_28{at}


Natalie King and Ramabhadran Balaji give a guide to the two year core medical training programme

Core medical training (CMT) is a notoriously challenging two year programme that bridges the gap between foundation and specialty registrar training. It is often said to feel more like service provision than a training post: a national survey of core medical trainees in 2013 highlighted both variability in the quality of supervision and the fact that service demands took up most of the trainees’ time.1

Nearly half of trainees did not feel adequately prepared to progress to the role of medical registrar.2 This article will help guide current and future trainees in meeting curriculum requirements, but also provide advice on getting more out of the programme.

Getting to know the curriculum

Most trainees will be familiar with the e-Portfolio, but should be aware that this cannot be accessed until they have enrolled with the Joint Royal College of Physicians Training Board (JRCPTB). The current fee is £338.3

The curriculum consists of clinical presentations in addition to common competencies, for which you need to build up an evidence base over the two years.

The CMT decision aid, which can be found on the JRCPTB website, gives a summary of what needs to be achieved by the end of each year and should quickly become your best friend.4

Collecting evidence of your experience in over 50 clinical presentations can be an overwhelming task if left to the last minute, therefore it is essential to familiarise yourself with what’s needed early on.

Evidence can take the form of supervised learning events, other workplace based assessments, teaching, e-learning, and reflective practice.

Supervised learning events

Trainees will already have experience of case based discussion and mini clinical evaluation exercises. The acute care assessment tool (ACAT), however, is a more complex method that looks at clinical assessment and management of at least five patients, and considers other factors such as team working, documentation, and handover.

The best time to complete your ACATs is on the acute medical take, as you are likely to see several patients in a shift; however they may also be used to assess performance leading a ward round or occasionally in clinic.

When sending a ticket request for an ACAT it is a good idea to summarise the cases seen in an email to the assessor, which they can refer to easily when completing the form.

A minimum of 10 consultant led supervised learning events (SLE) are required per year, four of which must be ACATs.

Registrars may complete additional SLEs—this is worthwhile educationally but will also give further evidence of competencies.


Gaining outpatient experience is a crucial but difficult requirement that will vary greatly depending on where you complete your training.

If you are lucky your trust will have allocated you protected time for clinics, if not you will have to arrange this yourself.

You will need to attend at least 24 clinics by completion of CMT, and these should be logged via reflective practice on your e-Portfolio.

Be aware that ambulatory care clinics are not counted.

Membership of the Royal College of Physicians

Passing all three parts of the Membership of the Royal College of Physicians (MRCP) exam is a challenging and costly feat in just two years. Make sure you use your study leave (up to 30 days) and budget, which can help with attending courses and personal revision.

Most hospitals will arrange bedside teaching for the Practical Assessment of Clinical Examination Skills (PACES) examination. Look out for mock PACES examinations which are arranged by many deaneries.

Thinking ahead to specialty training 3 posts

Specialty training year 3 applications come round very quickly—in the February of CMT2. Accumulating points for the application form—on top of your training requirements and preparing for exams—is challenging.

Remember that you have ample study leave to arrange a taster week in your chosen specialty or to attend courses.

Carrying out and presenting a relevant quality improvement project (at least one a year is required for CMT) will gain you valuable points for your application, while also demonstrating commitment to a specialty.

Look out for regional quality improvement presentation days that are organised by deaneries.

Preparing for medical registrar

The jump from CMT to medical registrar is a daunting prospect for many trainees. To help bridge this gap there is simulation training available to prepare trainees for the medical registrar role, particularly in leading the acute medical take.

Once you have passed your membership exams try to arrange opportunities to “act up” as medical registrar under supervision, which will give you valuable experience before taking on this role yourself.

Top tips for getting more out of your training

  • You have three regional training days a year—it is your responsibility to book study leave to attend these, so liaise early with your rota coordinator

  • Look out for valuable simulation training days in procedural skills, medical emergencies, and “acting up” as a medical registrar

  • Use your study leave and budget (30 days per year; budgets vary by deanery)—they are particularly helpful for MRCP revision courses

  • Meet regularly with your educational supervisor to make sure you are on track in signing off curriculum competencies

Useful Links


  • We have read and understood BMJ policy on declaration of interests and declare that we have no competing interests.