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24 October 2014
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CMT - An Introduction

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Core Medical Training is fundamental in the training towards many medical specialties during which the trainee gains experience in a broad range of medical specialties:

The trainee gains experience in a broad range of medical specialities through seeing and treating acutely ill patients during acute unselected medical take and assessing patients with chronic disease in outpatients. This is in addition to learning whilst caring for the acutely unwell medical in-patients.

The dynamism of the medical specialities is reflected in the many recent major clinical and scientific advances and this provides the constant stimulation that makes medicine exciting for many physicians.

Specialty Attractions

Specialties contributing to Core Medical Training include:

  • Acute Medicine
  • Cardiology
  • Dermatology
  • Diabetes and Endocrinology
  • Geriatrics
  • Gastroenterology
  • Haematology
  • Intensive Care
  • Oncology
  • Renal Medicine
  • Rheumatology
  • Stroke

The six 4 month posts provide ample opportunity for gaining a broad experience in the medical specialties as well as acquiring specialty specific skills and knowledge. The rotations are flexible and are constructed to accommodate the trainees’ expressed educational needs. The concomitant exposure to the acute medical take enables the trainees to use the acquired specialty specific skills in a way that constructively provides the trainee with experience and confidence.

The wide range of conditions seen during Core Medical Training ensures that the trainee is constantly learning and developing; it encourages the trainee to keep up to date with whole range of medical conditions. The breadth of experience is ideal and essential for the doctor of the future who will encounter an increasing proportion of medical patients with multiple co-morbidity.

The aspiring trainee would have the opportunity to gain skills and competence in the practical procedures associated with many of the medical specialties, e.g. chest drain insertion, central venous cannulation, lumbar puncture, bone marrow biopsy, and ascitic drain insertion.

The nature of many of the medical specialties ensures that the trainee gains experience in working in many different hospital environments such as Accident and Emergency, the Acute Medical Unit, both medical and non-medical wards, out-patients, procedural rooms, and specialty specific areas including the dialysis unit, endoscopy suite, catheter laboratory to name a few.

For the majority of posts the trainee will be working in a team. The necessary team working enables the development of leadership skills particularly when working with Foundation Year doctors, nurses and professionals allied to medicine.

For each trainee there is the opportunity to actively improve delivery of care whilst gaining an enhanced understanding of hospital management through the mandatory completion of a “Quality Improvement Project”. There is an annual national meeting during which the best projects are presented with prizes awarded for those that are outstanding. For a few this would provide further gratification and satisfaction beyond that derived by improving patient care and safety.

Is CMT the job for me?

Core Medical Training is essential if you wish to progress towards higher training for most of the medical specialties; exceptions include palliative medicine which can take trainees from GP, and dermatology which can take trainees from paediatric core training.

It provides the opportunity for developing skills in the management of both acutely ill patients and those with chronic disease. The diagnostic challenge associated with the need to promptly deliver urgent treatment in the care of the acutely ill patient provides valuable experience in developing the skills necessary in caring for most medical in-patients and those referred to medicine by other specialties. In contrast, chronic out-patients will require clinical decision making towards achieving long-term objectives and the provision of support to enable them to cope with their chronic conditions. For many physicians the continuity of care arising from the regular contact with their out-patients leads to immense job satisfaction and a different set of challenges including enhancing patient understanding and acceptance of their medical problems with the aims of improving concordance with treatment and coping with long-term chronic illness.
 
For trainees who like problem-solving, the challenge of defining working diagnoses is inherently rewarding, particularly when combined with determining the most efficient and appropriate diagnostic pathway. This will provide the doctor of the future with the necessary experience and confidence to overcome the diagnostic challenges of the increasing proportion of patients with complex co-morbidity.

Core Medical Training is particularly suited for those who have stamina and like challenges. However, for many medical specialties there are also rewards for those who enjoy providing continuity of care to their long-term out-patients.