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Shape of Training
Frequently asked questions about training in Neurology.



We have received a number of enquiries about the changes associated with the implementation of the Shape of Training reforms.  The next few years will be a time of considerable adjustment for trainees in neurology and for existing consultants. There are still uncertainties about exactly how some of the changes will be implemented.


We have put together what we think are the most accurate answers, at the time of writing (March 2020), to questions that have been raised by prospective and current trainees in Neurology and by consultants.  We would welcome your comments about our answers, and thoughts about important questions that still need to be posed. The Neurology Specialist Advisory Committee (SAC) and the Association of British Neurologists (ABN) are receiving information and updates from a number of sources, and we offer the following information mindful of the possibility that some issues require more detail and clarity.  


Although the discussions have been going on for some time, some may find it helpful if we first recap the process (including the involvement of the Association of British Neurologists (ABN) and the Association of British Neurologists Trainees (ABNT)) that has brought us to the current situation.


As part of the reforms linked to the Shape of Training review (October 2013) it was proposed that all major specialties spend three years in Internal Medicine Training (IMT), before going on to four years of specialty training which would include one year’s worth of more Internal Medicine.   Neurology presented a strong case to the Shape of Training Steering Board (Jan 2017) for focussing on Acute Neurology and Stroke, rather than engaging with more Internal Medicine, but our proposal was not accepted.


The Specialist Advisory Committee (SAC) in Neurology, with the agreement of the Association of British Neurologists (ABN), then negotiated to extend the period of time for specialist training from four to five years, and in October 2019 received approval, for a five-year training programme, from the Curriculum Oversight Group (COG), predicated on our continued engagement with Internal Medicine and inclusion of stroke competencies in to the neurology curriculum.


For those not familiar with the likely standard training pathway in Shape of Training (which started with Internal Medicine training in August last year, 2019), one way to remember it is on the fingers of one hand: one medical degree, two years Foundation Programme, three years of Internal Medicine Training, four years for the majority of Group 1 specialties, but five years for Neurology and Cardiology.


The curriculum for neurology is currently being rewritten. The eight key Capabilities in practice (CiP’s), which were presented in outline form in the ABN in 2019, have now been agreed for neurology specialist training, along with the Capabilities in Practice (CiP’s) for Internal Medicine, which all trainees will need to achieve in order to achieve a Certificate of Completed Training (CCT).  Neurology trainees will also complete the three Stroke Capabilities in Practice (CiP’s) and have stroke included as a subspecialty in their GMC registration.


The detail of the requirements within each of these CIPs (now in their fourth drafts) were the main agenda item at the most recent meeting of the neurology Specialist Advisory Committee (SAC) on Weds 26/2/2020.  The territories of practice covered by the eight include movement disorders, neuromuscular disease, headache and pain, neuropsychiatry and functional disorders, disorders of cognition, inflammatory and infectious disorders, epilepsy, and neurorehabilitation including traumatic brain injury.


There have been significant concerns about the detrimental effect of curriculum changes, in particular the implications for patient safety of trainees returning to internal medicine after a significant time out.
 
To try and address all concerns, and to update those already in training on the 2010 curriculum as well as aspiring trainees, we have prepared the following FAQ document (link).


The Joint Royal College of Physicians Training Board (JRCPTB)- the body of the three colleges that oversees the 33 Specialist Advisory Committees (SACs, ranging from cardiology and neurology to aviation medicine) -  has also produced some useful information (see links at end of FAQs).


 If your particular circumstances are not covered by this, you may wish to discuss your case with your local Training Programme Director (TPD) in neurology, your postgraduate lead in medicine, the ABNT on chair@abnt.org.uk, or the Chair of the Neurology SAC on TomTudorHughes@wales.nhs.uk.
 
Yours  

ARR   TATH  AP RNR                                                                                                      
 
 
 
Shape of Training Frequently Asked Questions.

 
Thank you for consulting this source of information.  We are updating it as new information comes in. This page was last reviewed on 7/3/2020.


1. I am a Foundation Trainee (or medical student) and I want to train in Neurology.  What is the career pathway in Shape of Training?

Following completion of your Foundation Training you need to apply in open competition for Internal Medicine Training (IMT), which is a three-year programme.  This started in August 2019 and replaced Core Medical Training (CMT).  

During the third year of Internal Medicine Training (IMT) you will then have to apply for specialty training in Neurology, again in open competition.
 
Specialty training in the majority of medical specialties will be four years, but in Neurology will be five.

The Neurology curriculum will include stroke, and all Neurology trainees will dual train in Internal Medicine. This will include at least one year of general medicine within the five-year specialty training programme, with three months in the final year of training. 
 
The individual posts in a rotation, and rota commitments for Neurology, Stroke and general medical “take” at different stages of training will be organised by local health boards/trusts, with deanery oversight to ensure completion of the curricula.


 
 
2. When will the new curriculum be introduced?
 
The new curriculum in Internal Medicine has started: Internal Medicine Training (IMT) began in August 2019, and is for three years.

From August 2022, all new Neurology trainees (i.e. those appointed in March/April 2022 after national interviews) will be required to dual train in Internal Medicine. Neurology training will also include training in Stroke, and lead to Certificates of Completed Training (CCTs) in Neurology and Internal Medicine, with subspecialty accreditation in Stroke.  

Neurology will be a group 1 specialty from 2022 onwards, along with Cardiology, Gastroenterology, Care of the Elderly and Renal etc.  All Group 1 specialties train in their parent specialty and Internal Medicine, the majority over four years.  Neurology will train over five years, based on the duration of its current training programme, and its commitment to Stroke.

Whilst it will not be possible to train in Neurology without completing training in Internal Medicine, following the award of both CCTs you can apply for jobs which involve just Neurology, or just Stroke, or indeed just Internal Medicine.


 
 
3. I am a Core Medical Trainee (CMT2) and will complete my training in August this year, 2020.  What are my options if I want to train in Neurology?
 

We think you have two options.  

You may have already applied for specialty training in round one, for posts starting in August 2020 and have been invited to national interviews on 18th and 19th March 2020. Or you may be planning to apply in round two for posts starting in February 2021, for which interviews are likely to be in Sept/Oct 2020.
 
If successful you will start on the current five-year 2010 curriculum, not the one that will be introduced in August 2022.  However, with some important exceptions (see below), our current understanding is that the General Medical Council (GMC) will expect all trainees to transfer to the new curriculum by August 2024. You will still be in training in August 2024.
 If you were to take a year out, the same would be true if you applied in 2021 for an August start or if there is a round 2 recruitment in 2021, for a February 2022 start. You would be on the current 5-year Neurology curriculum but the GMC will expect all trainees to transfer to the new curriculum by August 2024.

Alternatively you can wait and apply for a training post beginning in August 2022 (or later).  As you have completed core medical training (CMT, 2 years) you will need to complete either a stand alone Internal Medicine Year 3 (IMY3) post (a one year post to complete the competencies of the third year of the new curriculum, starting August 2021), or demonstrate equivalent experience to this year (exact details of how this might work are awaited), in order to apply and be interviewed (March/April 2022) for specialist training posts starting from August 2022.
 
If you were to delay applying until 2022, if successful you would automatically start on the new curriculum


 
4.  Will there be specialty recruitment in 2021?

Our current understanding is that there will be recruitment for Neurology training posts starting in August 2021, but there may not be a round two, for jobs starting in February 2022.

As usual, applicants will need to have completed Core Medical Training (CMT) or equivalent and hold MRCP PACES prior to starting their ST3 posts.





5. When will existing trainees be required to transition on to the new curriculum?
 
The GMC has a policy that all trainees transfer to a new curriculum within two years of its first implementation, to ensure that all trainees are on the up-to-date curriculum. There are some important exceptions to this rule (see below).
 
Therefore from August 2024, all Neurology trainees will be expected to transition to the new curriculum, which includes stroke and internal medicine. The GMC recognises that there will be some issues with this, and have allowed the following exceptions to this rule:

Any trainees whose training has been delayed (due to Out Of Programme/parental leave/less than full time training) before the start of August 2022 (when the new curriculum is introduced) will NOT be required to transition on to the new curriculum, or to dual train in internal medicine, whatever the total duration of training for these individuals.

We expect there to be other important exceptions related to sick leave, disciplinary issues, and disputes with ARCP and PYA outcomes, but await confirmation from the GMC. 
 
It is not currently specified whether concessions regarding transition from the old to the new curriculum will be dependent on a minimum time spent out of programme i.e. whether six weeks of sick leave for knee surgery or a short period of parental leave would be sufficient.


 

6. I am a current Neurology trainee, with a National Training Number (NTN). Will I be required to transition to the new curriculum?

If your CCT date is before August 2024, you will not be required to transition to the new curriculum. You will complete your Neurology training, and acquire a CCT in Neurology, without any CCT in stroke or general internal medicine. You will have followed the 2010 curriculum.
 
If your training pathway starts in August 2020 or August 2021, and you do not have any time out of training (OOP/parental leave/LTFT/sick leave) before the new curriculum is introduced in August 2022, (i.e. your CCT date would be expected to be August 2025 or August 2026 respectively), you will be expected to transition to the new curriculum, which again includes Internal Medicine, and Stroke, before August 2024.
 
If your training pathway starts in August 2020 or August 2021, and you have any delay (OOP/parental leave etc.) before the introduction of the new curriculum in August 2022, you will not be required to transition to the new curriculum and will complete the 2010 curriculum, i.e. you will train in Neurology, but not in Internal Medicine, and any stroke experience you acquire will not automatically lead to a sub-specialty CCT in Stroke.
 
If your training pathway starts in (or after) August 2022, you will complete the new curriculum and dual accredit in Internal Medicine, with a sub-specialty CCT in stroke.


 
 
7. I am doing a Neurology LAS and will be applying for Neurology training this year. Will I need to transition to the new curriculum?
 
If you are successful at national interviews and start as an NTN in August 2020, you have four years until August 2024 in which to complete your training on the 2010 curriculum.  Like other specialties, training in Neurology is competency-based, not time based, so if you can demonstrate that the necessary competencies have been completed in the four years as an NTN, you may be in a position to ask for your CCT to be accelerated by up to one calendar year. If that was the case, you may be able to obtain your CCT without changing to the new curriculum.  If you are not able to demonstrate this, based on our current understanding, you will have to transition on to the new curriculum.  

If your LAS has been signed off as equivalent to ST3 (for the sake of argument), and you are successful in your application for a National Training Number (NTN) you could use the Certificate of Eligibility for Specialist Registration- Combined Programme (CESR-CP) pathway. This would allow your year of LAS to be taken into consideration, alongside the competencies you go on to acquire – all logged on an eportfolio - in your approved training programme. 

As above, if you start Neurology training before August 2022 when the new curriculum is introduced, but have a delay in your training due to OOP/LTFT/parental leave before the new curriculum is introduced in August 2022, you will not be expected to transition on to the new curriculum and you can either complete the five year 2010 curriculum over a longer period of time, or choose to transition to the new curriculum.


 
8.  I have completed core medical training, and have been OOP since then (e.g. doing a PhD) and now wish to apply for Neurology training.  What should I do?
 
We would encourage you to complete your PhD/other OOP and get the most from your experience. The next application deadline will be June-July, for interviews sometime in September or October 2020, to start posts in Feb 2021.  Probably, the same basic timetable will apply for 2021/22, so there may be up to three opportunities to start training on the existing 2010 curriculum. However you will still be in training in 2024, so unless there is a delay to your training before August 2022 (see above), you will be expected to change to the new curriculum before August 2024.
 
The alternative, as someone who has completed two years of Core Medical Training, would be to apply for an Internal Medicine Year 3 (IMY3) post, i.e. a post following the curriculum for the third year of Internal Medicine Training.  Doctors who have completed Core Medical training i.e. had an outcome 6 at their final ARCP after two years of training, will be eligible to apply for these Internal Medicine Year 3 (IMY3) posts.  The earliest you can apply for these posts is Spring 2021, to start in post August 2021.  You would then be joining the first cohort of trainees doing Internal Medicine Year 3 (IMY3) posts.
 
You would then, assuming successful completion of competencies and an outcome 6 at final ARCP, be eligible to apply for Neurology specialty training to commence August 2022, on the new curriculum.


 
9. I have completed a post graduate research degree (eg. 3/4 year PhD or MD) in Neurology, and been granted 12 months credit towards Neurology training. Will I be able to use this to shorten my training to 4 years starting in August 2020?
 
Yes, probably, but this can only be the case if you already have a National Training Number (NTN) and you obtained prospective approval from the GMC for time in research to count towards your clinical training. Credit is applied at the first ARCP after your return to the training programme, but of course you need to go through the usual ARCPs and your PYA, and be awarded an outcome 6 at your final ARCP, in order to complete your training.

All being well, if the credit is applied, you should be able to start clinical training in August 2020 and CCT in August 2024.  

However, it is unusual for a trainee to take up an NTN post and then immediately go in to an out-of-programme activity without having done at least one year of clinical training.  You must ensure that you have received prospective official approval, from your deanery and the Joint Royal Colleges of Physicians Training Board (JRCPTB) confirming that your time out of programme will count towards your clinical training.


10. I have completed a post graduate research degree in Neurology (e.g. 3/4 year PhD or MD) Will I be able to use any of this time to count towards my Neurology training, and therefore shorten my training to 4 years starting in August 2020?


You cannot count time in research towards clinical training unless you have an NTN, you have received prospective approval to go out of programme, and confirmation that some of that time will count towards training.  
However, it may be possible to accelerate your CCT and bring it down by up to one calendar year if you can demonstrate completion of all required competencies at your final ARCP.  If you decide to attempt this we advise you to inform your Training Programme Director (TPD) and the panel at your next and future ARCPs, in order to get specific feedback about the progress you are making in your clinical training.

11. Will I be able to train solely in Neurology and enter the specialist register through the CESR route?

It is possible now, and probably until August 2024, to collate evidence of training in Neurology acquired outwith a conventional UK training programme and submit an application to the GMC for a Certificate of Eligibility for Specialist Registration (CESR, formerly know as Article 14). If you have already started on this route, and anticipate finishing before August 2024, this is still an option for you.

However, from August 2022 onwards training in Neurology will be inextricably linked to training in Internal Medicine therefore it is highly likely that the evidence of training required to be awarded a CESR will change to reflect the components of the new Neurology curriculum (including competency in the 8 general internal medicine Capabilities in Practice).  We expect the GMC to issue clear guidance in the near future about the changes required in the CESR process to reflect the new curricula in all of the specialties, particularly those experiencing the biggest changes in Shape of Training i.e. Neurology, Palliative Medicine, and Genitourinary Medicine.

For more information, the GMC guidance can be found here: http://bit.ly/GMCCESR

12. I started training in Internal Medicine in August 2019, and plan to apply for training in Neurology to start in August 2022.  Therefore I will be following the new curriculum.  Will I be able to dual train in Neurophysiology?


It seems likely that this will not be possible.  The main reason for this is that the GMC do not allow physicians within a single training programme to acquire more than two CCT’s. All those training in the Group 1 specialties will acquire a CCT in their specialty (Renal, Gastro, Neurology etc) and in Internal Medicine.  Some will acquire a sub-specialty CCT in a related territory e.g. Stroke, but within their training programme they will not be able to acquire a third CCT.  
For trainees who are currently in a neurology post, following the 2010 curriculum, there are training programmes that combine Neurology and Neurophysiology, but it seems inevitable that these programmes will have to be reviewed before August 2022.
There may be opportunities to acquire specialist skills in dedicated areas during or after your Neurology specialist training, but it not currently clear exactly how this will work.

Other helpful websites:

https://www.st3recruitment.org.uk/
https://www.jrcptb.org.uk/specialties/neurology
https://www.hee.nhs.uk/


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Association of British Neurologists
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Telephone: +44 (0)20 7405 4060
Email: info@abn.org.uk

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