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Acute Internal Medicine

acute doctorNature of the work

Acute Internal Medicine (AIM) is the specialty within medicine that is concerned with the assessment, diagnosis and management of adults presenting to secondary care with acute medical illness. There is a broad spectrum of clinical work within the specialty, including the immediate management of life-threatening medical emergencies, the initial treatment (first 72 hours) of all acutely presenting medical ailments, and the provision of ambulatory care. There is also a strong focus on management and leadership, allowing doctors who train in Acute Internal Medicine to run successful Acute Medicine Units (AMUs)

Working in acute internal medicine

This is a hospital-based specialty, and the majority of the work involves caring for medical patients around the time of their admission to hospital. The spectrum of clinical problems encountered in the AMU is very wide, which gives the work a great deal of variability and enables trainees to become experts in assessment, investigation, diagnosis and management across multiple disciplines.

There is a focus on the recognition and management of acute medical emergencies, but also on the development of ambulatory care systems for patients with medical problems who do not require immediate admission or indeed are better treated on an out patient basis. Multidisciplinary team working is key to an effective AMU; input from nursing staff, physiotherapists, occupational therapists, pharmacists and social workers is essential for a well-functioning unit.

Associated sub specialties

Acute Internal Medicine was formally recognised as a specialty in 2009, having previously been a subspecialty of General Medicine. The development of specialist skills is a mandatory part of training in the specialty. Some trainees will choose to learn a practical procedure such as echocardiography, while others will gain qualifications in management, leadership or education, and some will become involved in medical research.  The requirement to develop an additional skill or qualification is a key element of the new curriculum.

Acute Internal Medicine is distinct from Emergency Medicine (A&E), although specialist acute physicians should work in close collaboration with specialists in Emergency Medicine. There is also a close relationship with Critical Care, and some trainees in this field will choose Acute Internal Medicine as their ‘base’ speciality, before acquiring dual qualification by CCT or certification with Critical Care Medicine.

Common Procedures / interventions

The breadth of the specialty is such that a huge range of interventions will be practised. These include:

  • airway manoeuvres, including endotracheal intubation
  • insertion of central venous catheters
  • insertion of pleural and peritoneal drains
  • DC cardioversion

Some trainees will also learn how to perform specialist diagnostic or therapeutic procedures such as echocardiography, bronchoscopy and upper G-I endoscopy.

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