The new Endocrinology and Diabetes Specialist Training Curriculum, developed by Asif Ali and the Specialist Advisory Committee, went live in August. It is a necessary change to meet the needs of an ageing population with a range of complex co-morbidities. The new curriculum is more patient-focused and generalist in the early years, whilst including recent developments within the specialty.

CHANGING WITH THE TIMES

Since COVID-19, care has radically shifted and is being delivered differently. Challenges in the medical workforce have been widely reported and are likely to continue. The new curriculum has a strong emphasis on the development of essential human skills, such as leading and managing multidisciplinary teams. These skills will be essential for working with our specialist nurse colleagues, primary care and allied specialties for future care.

Training now needs to reflect our practice, with remote consultations, along with robust advice and guidance. A core skill of current trainees is confidence in educating non-specialist colleagues and patients in self-management, which will strengthen care overall within our population.

TIME TO CHANGE ‘THE NOISE’ AROUND OUR SISTER SPECIALTY?

General and acute medicine has been notoriously tough in the last few years, particularly at medical registrar level. This has repeatedly been cited as a reason not to pursue our specialty. These challenges still remain, but the tide is turning. With the introduction of Internal Medicine Training Year 3 (IMT3), and additional specialties required to dual-train in general medicine, the registrar rotas have a chance to fill properly and allow some leeway to lessen the burden on our trainees.

Moreover, general medicine is exciting and gives us an opportunity to be ‘in charge’ of the hospital. As a registrar, your opinion is listened to. You get to work through the most challenging cases and really save lives. Medical registrar training is for a short period (compared with a long career as a consultant). As generalists come through, there will be less acting down at consultant level. We can’t pretend that doing a medical registrar shift doesn’t sometimes come with anxiety and tension, but it also comes with interesting pathology, the ability and chance to make a real difference and lead a team. And as a specialty that looks after the whole system, we are in an excellent position to be highly skilled for this role.

WHAT ARE THE CHALLENGES?

Training remains precarious in a post- (or peri-)COVID-19 world. Some trainees have suffered with their own health, or have missed training opportunities and had to extend their training. In addition, we have the challenge of delivering the same curriculum along with more substantial internal medicine training requirements in four years rather than five.

As a specialty, we have always played an important role in supporting general (and acute) medicine, but this has meant that specialty training has been sacrificed for service requirement. Many people entering at ST4 level will have had only limited experience in outpatients and no experience in specialty, meaning that they take time to be able to expand to see a whole clinic list confidently.

As an indicative number, we have recommended that trainees should be attending three clinics a week over the four years. When this is averaged out, and including time in acute medicine, there will need to be weeks devoted to specialty (and many more clinics) to be able to achieve this.

BALANCING GENERAL MEDICINE WITH SPECIALTY TRAINING

We have campaigned for some time to protect specialty training from the impact of internal medicine service requirements, and have asked for this within the new curriculum, but this needs to be delivered locally. We want deaneries to ensure parity across all specialties. Our outpatient experience is our ‘procedure’. Now is the time for all of us (trainees and educators) to talk to our Trusts and explain our positions and need for parity with other specialties.

Alongside better staffed medical rotas, we can offer training to some of the registrars who may need more general medicine exposure (such as rheumatology or palliative care trainees). We can offer a different way of working: for example, covering stress points such as early evening, setting up a formal admission prevention service, covering more inpatient specialty to reduce length of stay, increasing weighting of rotas to winter. Encouraging less than full-time trainees to consider endocrinology is another opportunity to strengthen our recruitment.

HOW IS THE NEW CURRICULUM DIFFERENT?

One of the key developments is the introduction of capabilities in practice (CiPs) which are higher level evaluations of capabilities rather than atomised competencies. There are CiPs for internal medicine which are common across all group 1 curricula, and seven CiPs which are specific to endocrinology and diabetes. Areas of development include genetics, gender medicine and diabetes technology.

In addition, there is encouragement towards new ways of learning through simulation training, multidisciplinary teams, advice and guidance. The educational supervisor will be the key conductor, to ensure the training runs smoothly, and they will be responsible for a holistic assessment of outcomes.

WHY SHOULD TRAINEES CHOOSE ENDOCRINOLOGY AND DIABETES?

We offer a diverse curriculum which is fit for the future priorities of population health, general medicine and superspecialty expertise. Endocrinology and diabetes often acts as a springboard for research, leading teaching and management.

It is no surprise that the workforce survey shows that many endocrinologists have other strings to their bows. Often our role is to be a strong advocate for patients and to explain complex conditions, understand the subtleties that make diagnostics a challenge and negotiate the path for patients. A perfect combination and opportunities for whatever portfolio you wish to develop.

Antonia Brooke
Chair of Specialist Advisory Committee (Endocrinology and Diabetes), and Honorary Clinical Senior Lecturer, University of Exeter, Clinical Lead Endocrinology, Diabetes and Metabolism, Royal Devon and Exeter Hospital