Specialty specific changes for CESR in Geriatric Medicine

The Geriatric Medicine curriculum was published in January 2022. For a transition period, you can make your CESR application against either the new curriculum or the previous version.

This option is available until the transition deadline of 31 August 2023.

Specialty specific guidance

We’ve produced guidance documents for each version of the curriculum with the Joint Royal Colleges of Physicians Training Board.

How to apply

You can apply through your GMC Online account. There is one application form which includes sections for both versions of the curricula. You should tell us which curriculum version you wish to be assessed against in sequence one. And only provide evidence in the sections of the application relevant to your curriculum.

2022 curriculum

Our standards for postgraduate medical curricula are Excellence by design and the framework for Generic professional capabilities. These help postgraduate medical training programmes focus trainee assessment away from an exhaustive list of individual competencies, towards fewer broad capabilities needed to practise safely from your first day as a consultant.

As a result, the 2022 physicianly curricula are outcomes based. This means trainees will be assessed against the fundamental capabilities required of consultants in the working week. These include the general skills which all doctors need to have as well as those needed to carry out all the specific day to day tasks undertaken by a consultant physician (Capabilities in Practice – CiPs).

The Geriatric Medicine curriculum is made up of six Generic CiPs which are common to all physicianly specialties, eight clinical internal medicine CiPs, seven Specialty CiPs unique to Geriatric Medicine and one additional specialty CiP to be selected from five optional practices.

In demonstrating these capabilities, a successful applicant will be awarded a dual CESR in Geriatric Medicine and General Internal Medicine. 

Content shared between all physicianly specialties

There are six CiPs which are shared between all physicianly specialties:

  • CiP 1 - Able to function successfully within NHS organisational and management systems
  • CiP 2 - Able to deal with ethical and legal issues related to clinical practice
  • CiP 3 - Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement
  • CiP 4 - Is focused on patient safety and delivers effective quality improvement in patient care
  • CiP 5 - Carrying out research and managing data appropriately
  • CiP 6 - Acting as a clinical teacher and clinical supervisor.

Clinical internal medicine content

  • CiP 1 - Managing an acute unselected take
  • CiP 2 - Managing the acute care of patients within a medical specialty service
  • CiP 3 - Providing continuity of care to medical inpatients, including management of comorbidities and cognitive impairment
  • CiP 4 - Managing patients in an outpatient clinic, ambulatory or community setting, including management of long-term conditions
  • CiP 5 - Managing medical problems in patients in other specialties and special cases
  • CiP 6 - Managing multidisciplinary team including effective discharge planning
  • CiP 7 - Delivering effective resuscitation and managing the acutely deteriorating patient
  • CiP 8 - Managing end of life and applying palliative care skills.

Specialty specific content

  • CiP 1 - Performing a comprehensive assessment of an older person, including mood and cognition, gait, nutrition and fitness for surgery in an in-patient, out-patient and community setting
  • CiP 2 - Managing complex common presentations in older people, including falls, delirium, dementia, movement disorders, incontinence, immobility, tissue viability and stroke in an in-patient, out-patient and community setting
  • CiP 3 - Managing older people living with frailty in a hyper-acute (front door), in-patient, out-patient and community setting
  • CiP 4 - Managing and leading rehabilitation services for older people, including stroke
  • CiP 5 - Managing community liaison and practice
  • CiP 6 - Managing liaison with other specialties such as surgery, orthopedics, critical care, oncology and old age psychiatry
  • CiP 7 - Evaluating performance, and developing and leading services with special reference to older people.

In addition, applicants must demonstrate one of the following specialty themed for service CiPs:

  • CiP 1 - Able to manage older patients presenting with fracture and is able to provide a comprehensive orthogeriatric and bone health service
  • CiP 2 - Able to assess patients with urinary and fecal incontinence and is able to provide a continence service for a specific patient group in conjunction with specialist nursing, therapy and surgical colleagues
  • CiP 3 - Able to manage ill or disabled older people in a hospital at home, intermediate care and community setting and is able to provide a comprehensive community geriatric medicine service
  • CiP 4 - Able to manage patients with a wide range of movement disorders at any stage and is able to develop a movement disorders service for older people
  • CiP 5 - Able to assess patients presenting acutely with stroke and TIA including suitability for cerebral reperfusion treatments and their subsequent ongoing medical management within an organised stroke service.

Changes in assessment tools

There has been no change to the workplace-based assessment methodology.

Changes in knowledge and skills

All JRCPTB specialties identified as group 1 will dual train in internal medicine (IM) and the IM learning outcomes have been embedded in the Geriatric Medicine curriculum. This curriculum will train doctors that are specialists with generalist skills to manage the acute unselected take and care of acutely ill patients.

The 2022 curriculum incorporates a new section on medicines optimisation, reflecting the knowledge and skills required to optimise and manage medicines in patients living with multi-morbidity and frailty. In addition, there is a greater focus on the core topics of delirium and dementia requiring some additional knowledge and skills in communication, including in challenging circumstances. This reflects the increase in complex multi-morbidity seen as a result of an ageing population and addresses the need for doctors with the knowledge and expertise necessary to manage older patients with frailty, multi-morbidity and dementia.

The new curriculum includes the requirement to complete a theme for service (orthogeriatrics and bone health, urinary and faecal incontinence, community geriatric medicine, movement disorders or stroke). The Geriatric medicine specialty CiPs (themed for service) have been carefully selected to meet current service needs.