Specialty specific guidance for CESR in Palliative Medicine
The new Palliative Medicine curriculum was published in June 2022. For a transition period, you can make a CESR application against either the new curriculum or the previous version.
This option is available until the transition deadline of 30 October 2024.
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.
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 Palliative Medicine curriculum is made up six Generic CiPs which are common to all physicianly specialties, eight clinical internal medicine CiPs and seven Specialty CiPs unique to Palliative Medicine.
In demonstrating these capabilities a successful applicant will be awarded a dual CESR in Palliative Medicine and General internal medicine.
Completion of three years Internal Medicine Training replaces Core Medical Training as the core training programme.
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
There are eight clinical CiPs for internal medicine which are shared between all group 1 specialties:
- 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 - Managing patients with life limiting conditions across all care settings
- CiP 2 - Ability to manage complex pain in people with life-limiting conditions across all care settings
- CiP 3 - Demonstrates the ability to manage complex symptoms secondary to life-limiting conditions across all care settings
- CiP 4 - Ability to demonstrate effective advanced communication skills with patients with life-limiting conditions, those close to them and colleagues across all care settings
- CiP 5 - Ability to manage, lead and provide optimal care of the complex dying patient and those close to them across all care settings
- CiP 6 - Manages delivery of holistic psychosocial care of patients and those close to them, including loss and grief; and religious, cultural and spiritual care across all care settings
- CiP 7 - Demonstrates the ability to lead a palliative care service in any setting, including the third sector.
- CiP 8 - Managing end of life and applying palliative care skills
Changes in assessment tools
The following changes have been made to workplace-based assessments and methodology:
Removal of DOPS: TENS machine is no longer required, while paracentesis, central or peripheral intravenous catheter management and NG tube application have been incorporated into the requirements for Internal Medicine.
A LEADER assessment or equivalent must be used to enable formal review of management and leadership skills.
Patient surveys are now required, including feedback from those close to patients.
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 Palliative 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.
There has been a rebalancing of clinical presentations to better represent the patient population seen in palliative care. This has been designed to retain knowledge and skills for managing cancer patients whilst also enhancing knowledge and skills to support people with a wide range of life limiting illnesses, including frailty, dementia, organ failure and multi-morbidity.
There have been significant additions to the new curriculum related to health promotion. This reflects emerging evidence supporting the importance of community engagement and development, and health promotion at the end of life.
These changes are in recognition of the emerging importance of palliative care services in supporting transitional care for teenagers and young adults, the new discipline of supportive care in cancer, and the challenges in accessing and meeting the needs of hard-to-reach groups.
There is no longer a requirement for a specialist inpatient unit or hospice to have 10 beds. Specialist units are now defined as “a unit that is consultant-led, with the appropriate skills and training in specialist palliative care to manage and support the complex symptom control, psychological and social needs of patients that cannot be managed in other settings’.
Additional detail can be found in the curriculum regarding the outcomes to be demonstrated from participation in specialty work on call / out of hours, and the range of settings considered appropriate for training and contributing to the community.