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 put together a series of FAQs in March 2020, responding to questions raised by prospective and current trainees in Neurology and consultants. This was intended to be a working document and we have, therefore, updated this guidance following further information from various sources, including the Joint Royal College of Physicians Training Board (JRCPTB) and General Medical Council (GMC).
We welcome your comments about the answers and thoughts about important questions that still need to be posed (email addresses below).
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 focusing - in the proposed four-year specialist training - on Acute Neurology and Stroke, rather than taking on 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 from the Curriculum Oversight Group (COG) for a five-year training programme. This was predicated on our continued engagement with Internal Medicine, and the inclusion of stroke competencies into the new neurology curriculum.
For those not familiar with the likely standard training pathway in Shape of Training (which started with Internal Medicine training in August 2019), it is sketched out below.
For ease of remembrance, training in Group 1 specialties involves one medical degree, two years Foundation Programme, three years of Internal Medicine Training, four years for the majority of specialties, but five years of specialty training for neurology (and cardiology), which will include at least one integrated year of Internal Medicine.
The curriculum for neurology is currently being finalised. The eight key Capabilities in practice (CiPs), which were presented in outline form in the ABN meeting in 2019, have now been agreed for neurology specialist training. In order to achieve a Certificate of Completed Training (CCT) in Neurology and Internal Medicine, trainees will have to complete the neurology CiPs and internal medicine CiPs.
The territories of practice covered by the eight neurology CiPs include movement disorders, neuromuscular disease, headache and pain, neuropsychiatry and functional disorders, disorders of consciousness and cognition, inflammatory and infectious disorders, epilepsy, and neurorehabilitation including traumatic brain injury. The expectation is that the curriculum will be submitted in early 2021 and implemented in August 2022. Neurology trainees will also complete the three Stroke Capabilities in Practice (acute, preventative, rehabilitation) and have stroke included as a subspecialty in their GMC registration.
To try and address all concerns, and to update those already in training on the 2010 (with amendments in 2013) curriculum, as well as aspiring trainees, we have prepared the following FAQ document.
The Joint Royal Colleges 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 at chair@abnt.org.uk, or the Chair of the Neurology SAC at TomTudorHughes@wales.nhs.uk.
Yours sincerely,
Amy Ross Russell, Tom Hughes, Anthony Pereira, Richard Rees and Matthew Jones (Updated 10/11/2020)
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 revised on 10/11/2020
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. Internal Medicine Training (IMT) 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 it will be five.
The Neurology curriculum will include stroke (as a sub-specialty) and all Neurology trainees will dual train in Internal Medicine. This will include at least one year of internal medicine within the five-year specialty training programme, with at least three months in the final year of training. Up to six months of stroke medicine will count towards training in Internal Medicine, leaving a minimum of six months more Internal Medicine to complete, three months of which must be in the final year.
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/HEE oversight to ensure completion of the curricula.
2. When will the new curricula be introduced?
The new curriculum in Internal Medicine (stage 1) has started: Internal Medicine Training (IMT-stage 1) began in August 2019 and is for three years.
All new Neurology trainees starting from August 2022 will be required to dual train in Internal Medicine (stage 2) using the new curriculum. 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. It will not be possible to train purely in Neurology.
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 future 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 consultant jobs which involve just Neurology, or just Stroke, or indeed just Internal Medicine.
3. I have completed Core Medical Training (CMT) and do not currently have a National Training Number. What are my options if I want to train in Neurology?
Depending on your situation there are at least three options.
Option 1
If you were successful in the Round 2 interviews in October 2020, you will start your training post in February 2021 and follow the current five-year (neurology only) 2010 curriculum. It will not be mandatory for you to change curriculum, even if your training is interrupted, but the GMC will be encouraging all those whose training is not complete by 2024 to consider changing to the new curriculum.
Option 2
You may be waiting for the next Round 1 application process to open (23 November 2020, with interviews on 23 & 24 February 2021) for posts starting in August 2021.
The General Medical Council (GMC) expect all trainees who start neurology training in August 2021 to transfer to the new curriculum, at the latest by August 2024.
Option 3
A third option is to wait and apply (interviews in Spring of 2022) for a training post beginning in August 2022. If you have completed core medical training you will need to complete either a stand-alone Internal Medicine Year 3 (IMY3) post or demonstrate equivalent experience to this year (exact details of how this might work are awaited), in order to apply.
Clearly, if you were to delay applying until 2022 and were successful, you would start on the new curriculum.
Option 4
It may be possible to apply for specialty training without doing an IM3 year, predicated on being able to acquire the competencies of IM3 during five years of specialty training in neurology, stroke and internal medicine. We await formal confirmation of this.
4. Will there be specialty recruitment in 2021?
There will be recruitment for Neurology training posts starting in August 2021. The application process will open in November 2020 and interviews will be in February 2021 for an August 2021 start. 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 before starting their ST3 posts. IMT2 trainees will not be eligible to apply for ST3 posts.
All trainees starting their training in August 2021 will have to transfer to the new curriculum which includes neurology, internal medicine and stroke.
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. The new curriculum will be formally introduced in August 2022.
Therefore, by August 2024 all Neurology trainees who start their training in August 2021 (or later) will be expected to have transitioned to the new curriculum (neurology/stroke/internal medicine). Trainees who start training before August 2021 will not be required to transition to the new curriculum, but - particularly when their training is prolonged - will be encouraged to do so.
The GMC recognises that there will be some issues with this and have allowed the possibility of exceptions to this rule. However, the exact specifics of this are not yet formalised. We expect there to be important exceptions including statutory leave or disciplinary issues.
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 training started before August 2021, or will be completed before August 2024, you will not be required to transition to the new curriculum and will complete the 2010 curriculum. This includes those people who have any time out of training for research (OOPR), other training experiences (OOPT/ OOPE/ OOPC), or parental leave.
If your training pathway starts in August 2021 or later, you will be expected to transition to the new curriculum, at the latest by August 2024. Clearly for trainees in this situation the sooner they change to the new curriculum the easier it will be to acquire the necessary training.
7. I have done/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 February 2021, you will not be required to transition to the new curriculum. You may be able to use some of your acquired competencies to count towards your training, and it is possible to request that your CCT date be brought forward by up to one year.
If you get your NTN in or after August 2021, then regardless of previous experience as a LAS or LAT (in Scotland or Wales) you will be expected to transition on to the new curriculum.
If your LAS has been signed off as equivalent to ST3 (for the sake of argument), whether or not 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. For more on CESR pathway see below.
8. I have completed core medical training and since then have been doing an MD/PhD. I do not have a National Training Number in Neurology. I now wish to apply for Neurology training. What should I do?
We would encourage you to complete your PhD/MD and get the most from your experience.
Your options are then the same as listed in Question 3.
9. Will I be able to train solely in Neurology and enter the specialist register through the CESR route?
It is possible now 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 known as Article 14). If you have already started on this route, and anticipate finishing in the near future, 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
10. 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?
This is not possible. The main reason for this is that the GMC does not allow physicians within a single training programme to acquire more than two CCTs. 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, including neurophysiology, during or after your Neurology specialist training, but currently it is not clear exactly how this will work, and in particular whether credentials in Neurophysiology will be available in the future.
Other helpful websites:
https://www.st3recruitment.org.uk/
https://www.jrcptb.org.uk/specialties/neurology
https://www.hee.nhs.uk/
https://www.jrcptb.org.uk/training-certification/less-full-time-training
