Optimisation and Progression of Training in Internal Medicine – In Search of Excellence (OPTIMISE)
The Institute of Medicine at the Royal College of Physicians of Ireland has commissioned a review of the Internal Medicine training programme. The review sets out to ensure the training programme is fit-for-purpose and graduates are being provided with the skills and expertise required to meet the needs of patients and society into the future. The review has been titled ‘OPTIMISE’ (Optimisation and Progression of Training in Internal Medicine – In Search of Excellence), and work has been carried out under the leadership of Prof Anthony O’Connor as Clinical Lead.
Context for Review
General internal medicine (GIM) is the core business of Irish hospitals, accounting for approximately two-thirds of hospital bed days. The preservation of general medical skills in an era of increased specialisation is critical to maintaining standards of care in Ireland, particularly in managing multimorbidity, frailty, and polypharmacy in our growing, ageing population.
Pressures on GIM manifest across the system as longer waiting times in emergency departments, increased numbers of patients placed in beds not suited to their specific needs, decreased efficiency in the discharge process, increased errors, and greater stress within the workplace.
The level of generalist skills in internal medicine is declining, with some regions prioritising the development of internists or hospitalists. The RCPI is committed to delivering a more structured training programme across BST and HST to better support physicians. A key aim of the RCPI’s Institute of Medicine (IOM), since it was established in 2020, has been to improve the governance and integration of general internal medicine training, and to ensure that training is reviewed, optimised, and benchmarked to international standards, graduating exceptional general physicians of the future.
OPTIMISE Interim Report
A formal interim report to detail the findings of our review and set out recommendations for an improved training programme in general internal medicine is now available. Planning to operationalise and implement the recommendations by 2025 is currently underway.
Five Key Pillars
There are five key pillars to the interim report:
- A New Approach for the Practice of the 2020s and beyond
- A New Approach for the Patients of the 2020s and beyond
- Providing the Resources to Train
- A new paradigm for the Trainer-Trainee relationship
- Championing Generalism
As part of the review, recommendations have been developed for an integrated, outcome-based training programme, with flexibility for change into the future. Recommendations on the resources required to deliver change into the future, and on continuous quality assurance and improvement for internal medicine training have also been outlined and a timeline, short, medium, and long-term, for rolling out and implementing changes in the programme are being developed.
The OPTIMISE project has reviewed current structures and practices in Ireland and benchmarked these against international training models in the UK, US, Australia, and the Netherlands. A steering group of General Internal Medicine experts has been established whose ongoing guidance and expertise continues to guide our direction and focus.
The OPTIMISE project team has consulted extensively with stakeholders, including Training Directors, Trainees, the Institute of Medicine board and officers, RCPI council and management, the acute medicine programme, the HSE National Doctors Training and Planning, and the integrated care team in the HSE.
Clinical Lead: Prof Anthony O’Connor
Project Manager: Ms Roisin Craven | Ms Anjitha Radhamoney