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Home/Faculties & Institutes/Institute of Medicine/Internal Medicine Training Restructuring - Project Updates
 

Internal Medicine Training Restructuring - Project Updates

 

Introduction

Those who attended IOM events during 2025 will have heard updates on the Internal Medicine Training Review. This project represents a strategic response to the OPTIMISE Report (2023), which outlines a comprehensive series of recommendations to enhance Internal Medicine Training (IMT) in Ireland. Factoring in work force planning, NCHD task force recommendations and feedback from key stakeholders including trainees and trainers an initial proposal for an updated BST programme was tabled for review in September 2025.

Through October, November and December we met with representatives across all six HSE Health Regions and various programmes to review, update and explore how this proposal may work in reality to improve the training experience in internal medicine. This included over 40 hours of one-to-one calls with trainers and site visits to discuss with the wider training teams in University Hospital Limerick, Letterkenny University Hospital, University Hospital Galway, Sligo University Hospital, Mayo University Hospital, St Lukes General Hospital Kilkenny and others.

The purpose of this phase was to test early proposals against operational realities and to understand the potential impact on training quality, supervision, patient care and trainee experience. As a result, the initial proposals have evolved through several iterations.

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Key principles emerging from consultation

The engagement phase has allowed a clearer set of shared principles to emerge. These principles are guiding the next stage of work and future formal proposals:

  • Improving the consistency, quality and overall experience of training for trainees across programmes and regions
  • Improving the quality and consistency of supervision and support for trainers and trainees
  • Reducing unnecessary variability in training experiences
  • Increased exposure to IOM specialities
  • Supporting a more sustainable training pathway aligned with workforce needs
  • Conversion of non-training posts to training posts to support this sustainability
  • Strengthening opportunities to train in Model 3 hospitals
  • Ensuring future changes are deliverable, funded, and appropriately governed.

Underpinning the above, investment  in supervision, flexible training options and appropriate upskilling are key to ensuring a competitive high calibre medical workforce of the future.

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Outline of the emerging programme model

(Subject to approval)

Based on consultation to date, an outline model has been developed for further refinement and formal consideration. This model is not yet approved and remains subject to funding, regulatory approval and national governance processes.

Highlights of what this proposal includes are:

  • Creating a Core Internal Medicine Training Programme of 3 year duration,
  • Reducing health-system reliance on stand-alone registrar posts outside of structured training programmes.
  • Providing clearly defined supervised registrar-level experience within the training pathway prior to entry to Higher Specialist Training
  • Development of 10 Programme Networks of Training sites
  • Equitable distribution of Training posts across networks
  • Increased training provision in Model 3 hospitals
  • Investment in administrative resources
  • A common first-year structure across all programmes
  • Ring fenced, structured and supervised registrar posts for year 3
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Indicative programme structure

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Summary of approach and next steps

The 10 new programme networks have been mapped to minimise movement of trainees between hospitals and all post locations will be preference on entry to the programme. Though this does not guarantee first preference will be offered, on commencement of the programme all trainees will have certainty of their post locations.

The revised Core IMT has been carefully considered in design to balance the widely varying factors that go in to providing an excellent training experience and supporting the needs of patients.

Any replacement of the current BST structure with a revised IMT programme would be subject to formal approval processes and funding, with no earlier implementation than the intake in July 2027.

Updates will continue to be shared via this webpage as the project progresses.

Last updated: December 2025

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