Core Medical Training

Core Medical Training is taken after F2, and therefore allows doctors to progress to higher specialist training.  The CMT curriculum generally takes two years to complete and involves four to six rotations through different specialties, in addition to acute on-call work throughout. It is essential for trainees to pass the Part One, Part Two, and PACES practical examinations for the MCRP by the end of CMT, otherwise they will not be eligible to apply for higher specialist training.

Core CMT Curriculum

The CMT curriculum sets out the essential competencies and standards that trainees must achieve for good medical practice. It also stipulates the formal assessments that trainees must complete during CMT. The competencies trainees are expected to learn are broadly divided into

• symptom-based competences, or the knowledge, skills, and attitudes regarding the clinical presentation of various medical conditions;
• system-specific competences, or basic science and medical conditions;
• investigation competences, or investigations trainees should be able to order and interpret; and
• procedural competences, or the procedures that trainees should be able to perform.

Symptom-Based Competences

Core Medical Training candidates are expected to demonstrate adequate knowledge of the following CMT curriculum competences:

• Emergency presentations – the management of incidences of cardio-respiratory arrest, shock, anaphylaxis, and other emergencies;
• Common or top presentations – dealing with conditions such as abdominal pain, acute back pain, acute kidney injury, chronic kidney disease, blackouts or collapse, breathlessness, chest pain, acute confusion/delirium, cough, diarrhoea, falls, fever, fits and seizures, haematemesis, melaena, headache, jaundice, limb pain and swelling, palliative care palpitations, poisoning, rash, vomiting and nausea, and weakness and paralysis;
• Working with a multi-disciplinary team to manage patients who need palliative and end-of-life care; formulating a management plan, and assisting with advance care planning; and
• Dealing with patients presenting with a variety of conditions, including
  • an abdominal mass or hepatosplenomegaly,
  • abdominal swelling and constipation,
  • paraesthesia and numbness,
  • aggression and disturbances of behaviour,
  • alcohol and substance misuse,
  • anxiety and panic disorder,
  • bruising and spontaneous bleeding,
  • dyspepsia,
  • dysuria,
  • genital discharge and ulceration,
  • haematuria,
  • haemoptysis,
  • head injury,
  • hoarseness and stridor,
  • hypothermia,
  • immobility,
  • involuntary movements,
  • swelling of the joints,
  • lymphadenopathy,
  • loin pain,
  • complications following surgery,
  • medical problems in pregnancy,
  • progressive memory loss,
  • difficulties with micturition,
  • neck pain,
  • physical symptoms without evidence of organic disease,
  • polydipsia,
  • pruritus,
  • rectal bleeding,
  • ulceration of the mouth and skin,
  • disturbances of speech,
  • suicidal ideation,
  • difficulties in swallowing,
  • syncope and pre-syncope,
  • unsteadiness and balance disturbance,
  • visual disturbances,
  • weight loss, and
  • patients with incidental findings.

System-Specific Competences

Trainees are expected to acquire knowledge of the common problems, clinical underlying science, and the competences specific to the systems of

• allergy,
• oncology,
• palliative and end of life care,
• cardiology,
• clinical genetics,
• clinical pharmacology,
• dermatology,
• endocrinology and diabetes,
• gastroenterology and hepatology,
• haematology,
• immunology,
• infectious diseases,
• geriatric medicine,
• musculoskeletal medicine,
• neurology,
• psychiatry,
• renal medicine,
• respiratory medicine, and
• public health and public health promotion.

CMT Curriculum Investigation Competencies

Doctors undertaking Core Medical Training should know the indications for and draw interpretation from

• biochemistry investigations such as
  • urea and electrolytes,
  • liver function tests,
  • glucose,
  • magnesium cardiac biomarkers,
  • creatinine kinase,
  • thyroid function tests, and
  • inflammatory markers;
• haematology investigations such as
  • blood counts,
  • coagulation screens, and
  • haemolysis screens;
• microbiology investigations such as
  • blood cultures,
  • urine cultures,
  • analysis of pleural, ascitic, and cerebro-spinal fluid,
  • tumour markers, and
  • autoantibodies;
• radiological investigations such as
  • chest radiographs,
  • abdominal radiographs, and
  • radiographs of the joints;
• physiological investigations such as
  • electrocardiograms,
  • peak flow tests,
  • lung function tests,
  • ambulatory blood pressure monitoring,
  • bone scans, and
  • V/Q scanning;
• endoscopy tests such as
  • bronchoscopies, and
  • upper and lower gastrointestinal endoscopies;
• pathology investigations such as
  • liver biopsies,
  • renal biopsies, and
  • lymph node biopsies; and
• cytology, namely
  • pleural fluid,
  • ascitic fluid, and
  • cerebrospinal fluid.

Core Medical Training Procedural Competences

The procedural competences are divided into three parts: essential procedures that

• the trainee must be able to perform, namely
  • advanced cardiopulmonary resuscitation and external pacing,
  • lumbar puncture,
  • placement of a nasogastric tube,
  • ascitic tap, and
  • pleural aspiration, or insertion of an intercostal drain for a pneumothorax;

• it is desirable for the trainee to perform independently, namely
  • central venous cannulation, with ultrasound guidance,
  • DC cardioversion, and
  • insertion of an intercostal drain using the Seldinger technique, under ultrasound guidance;
• it is desirable for trainees to get some experience of and, if possible, perform independently, namely
  • abdominal paracentesis, and
  • knee aspiration.

Although a number of these procedures are seen as desirable, it is expected that those trainees wishing to pursue a career in acute medicine should be able to perform these procedures independently. If this is not possible, they can demonstrate competency in these procedures by obtaining a course or skills lab certificate, or through clinical experience with a Direct Observation of Procedural Skills (DOPS) assessment.