Acute Medicine Portfolio Pathway applicants are assessed against Acute Internal Medicine with General Internal Medicine. A strong portfolio proves current, independent consultant-level work across the acute take, AMU, SDEC, escalation, specialist interfaces, discharge complexity, GIM and professional practice, not just years of senior acute medical experience.
What assessors are really testing
The GMC's Acute Internal Medicine Specialty Specific Guidance is explicit: this is an application for Acute Internal Medicine with General Internal Medicine. It is not a standalone acute medicine-only route. The SSG says the relevant high-level learning outcomes for GIM are demonstrated by meeting the requirements in the guidance, and that applicants also need to read the AIM and GIM or Internal Medicine Stage 2 curricula.
The central question is whether your evidence shows the knowledge, skills and experience required for UK specialist practice. For AIM, that means breadth and pace: acute diagnostic reasoning, prioritisation, parallel decision making, escalation, leadership of the AMU, safe discharge, Same Day Emergency Care (SDEC), interface working and senior responsibility in the unselected take.
Four things your evidence has to prove
For the wider evidence framework, read the Portfolio Pathway overview, the four GMC domains, the structured CV guide, the MSF plan, the audit guide, the reflective practice guide and the structured reports guide.
AIM plus GIM: do not separate them too neatly
A lot of senior doctors underestimate the GIM part. They have been running an Acute Medical Unit for years, so they assume the GIM capability is obvious. It rarely is unless the evidence is mapped properly. The acute take, medical inpatients, outpatients or ambulatory work, deteriorating patients and complex discharge all need to be visible.
What acute medicine has to show
- Leadership of acute medical services, not just participation in the rota.
- SDEC pathway work, ambulatory decisions and safe alternatives to admission.
- Escalation decisions for unwell patients and integration with ICU and specialties.
- A developed specialty skill that is credible and evidenced.
What the GIM layer has to show
- Management of the acute unselected take at senior independent level.
- Continuity of care for complex inpatients with comorbidity and frailty.
- Clinic, ambulatory or community-facing work where relevant.
- MDT leadership, discharge planning and end of life judgement.
The six Acute Internal Medicine specialty CiPs
The AIM SSG lists six specialty-specific capabilities. These are useful because they stop you from building a portfolio that is impressive but lopsided. A doctor who has endless acute take evidence but no SDEC, no community interface, no specialty skill and no service leadership evidence is still exposed.
AIM specialty capability map
Map each one separatelyManaging Acute Medical Services
AMU flow, leadership, decision making, education, governance and service effectiveness.
Alternative pathways and SDEC
Safe ambulatory care, admission avoidance, risk stratification and pathway development.
Prioritisation and escalation
Selection of patients by severity, uncertainty, treatment escalation and urgent review.
Specialist interfaces
Integration with ICU, cardiology, respiratory, geriatric medicine and other services.
Community interface
Complex discharge planning, community services, mental health interfaces and safe handover.
Specialty skill
A clinical, academic, research or procedural skill developed to a credible specialist level.
Evidence that carries weight in Acute Medicine
Good AIM evidence is observed, recent, mapped and triangulated. It is not enough to say you have worked in acute medicine for ten years. You need documents that allow an evaluator to see current capability across settings and responsibilities.
| Evidence type | Strong AIM example | Weak version |
|---|---|---|
| ACATs | Consultant-observed assessments across acute take or AMU work, showing independent prioritisation and global performance. | Old assessments, narrow cases or assessments that do not show level 4 entrustment. |
| Structured reports | Referees who directly observe AIM and GIM practice, including one internal medicine consultant and specialty colleagues. | Prestigious names who cannot comment on current acute work. |
| SDEC evidence | Pathways, cases, risk tools, audit/QI and examples of safe alternatives to admission. | A job description saying you work in ambulatory care. |
| Feedback | Recent MSF, patient survey, reflection and action plan covering your full senior role. | Small feedback exercises from one narrow group. |
| QIPAT or audit/QI | A completed project in recent practice with implementation, reflection and measurable impact. | A poster or idea with no closed loop or personal contribution. |
Download: Acute Medicine evidence map
A two-page worksheet covering SSG evidence numbers, procedures, job-evidence requirements and a 90-day portfolio reset plan.
SSG evidence numbers: useful, but not a shopping list
The AIM SSG gives indicative numbers for several evidence types. These are useful because they stop you from guessing. But the document also makes clear that the total number of documents and assessments is less important than quality, breadth and whether the evidence covers the required learning outcomes.
| Evidence area | Indicative SSG expectation | What it should prove |
|---|---|---|
| GIM ACATs | 6 ACATs showing independent performance at entrustment level 4. | Ability to manage acute GIM work with senior judgement. |
| AIM ACATs | 8 further AIM ACATs, separate from those used for GIM. | Acute take, AMU and prioritisation capability at AIM level. |
| OPCATs | 2 OPCATs to level 4 entrustment. | Outpatient, ambulatory or clinic-based judgement, not just ward work. |
| CbD / mini-CEX | GIM: 8 further SLEs. AIM: 8 further SLEs, with 4 within 12 months WTE of application. | Different aspects of the specialty, with recent evidence of consultant-level capability. |
| DOPS / procedures | Either a senior structured report on core procedures or one summative DOPS for each required procedure. | Procedural competence and maintenance, not just historical exposure. |
| QIPAT | 1 completed in the last 12 months of most recent practice. | Active involvement in audit, QI or service development. |
| Patient survey | Approximately 15 patients, with reflection, or equivalent breadth of patient feedback. | Communication, professionalism and patient-facing consultant practice. |
| MSF | Minimum one in the 12 months before submission, approximately 12 colleagues, medical and non-medical. | Teamworking, leadership, communication and reliability across the full senior role. |
| MCRs | 4 Multiple Consultant Reports in the last 12 months clinical practice WTE. | Direct consultant observation across AIM and GIM capability. |
| Uploads | Most applications are expected to include around 100 electronic documents. | Keep uploads manageable. Cross-reference instead of duplicating evidence. |
Procedures and acute practical skills
AIM is not assessed on service seniority alone. The SSG includes practical procedures for Internal Medicine and Acute Internal Medicine and expects evidence that applicants can perform the required procedures at the stated level of competence. In most cases, this means unsupervised competence, supported by logbooks, DOPS or structured-report confirmation.
Core procedures named in the AIM SSG
Use this as a gap-check, then collect current DOPS, logbook evidence or structured-report confirmation where appropriate.
Procedures are a good example of why a senior title is not enough. If your evidence says you are leading acute medical services, but there is no current proof of procedural competence or safe supervision of juniors performing procedures, the portfolio will feel thinner than your clinical reality.
Non-training doctors in physician specialties, including trust grade, clinical fellow, LAS, associate specialist and MTI doctors, can apply for Federation/JRCPTB ePortfolio access. For Acute Internal Medicine applicants, that can make it easier to collect recognisable physician assessments such as ACATs, CbDs, mini-CEX, DOPS and MCR evidence in a format assessors understand.
Evidence your post itself must produce
Some AIM evidence is not about you writing better reflections. It is about whether your job can produce the right documents. The SSG asks for employment evidence, job descriptions, rota samples, caseload data and appraisal or performance review evidence. That makes job fit a real Portfolio Pathway issue.
The job-fit evidence checklist
If these are hard to obtain, the role may be making the Portfolio Pathway harder than it needs to be.
SDEC, critical care and community interfaces
Acute Medicine portfolios often fail to show the edges of the job. The AIM specialty CiPs make those edges explicit: SDEC and alternative pathways, escalation decisions, specialist interfaces, and community services including complex discharge planning.
The Acute Medicine interface map
This is where a good post gives you better evidence. You need cases, pathways, meetings, audit, reflections and consultant observation that show how you work across the system.
Alternative pathways
Risk stratification, admission avoidance, ambulatory diagnostics, same-day treatment plans and evidence of safe decision making.
Escalation and deterioration
ICU interface, treatment escalation planning, non-invasive respiratory support, high-flow oxygen decisions and the first phase of critical illness.
Complex discharge
Primary care, community services, mental health interface, social care, safe handover and avoiding unnecessary admission or delay.
Common gaps in Acute Medicine applications
The most common weakness is not lack of seniority. It is mismatch. The doctor may be very senior, but the evidence only proves one part of the work. AIM assessors need to see breadth, current practice and safe independence across the whole standard.
Broad current acute practice
- Recent AMU, acute take, SDEC, GIM and clinic or ambulatory evidence.
- Consultant observation from people who see you carry risk and make escalation decisions.
- Clear mapping to generic, clinical and AIM specialty CiPs, with cross-referencing not duplication.
- Current procedure evidence and one coherent specialty skill with supporting proof.
- Rota, caseload, appraisal and departmental evidence that proves the role itself.
Senior but narrow work
- Lots of service provision but little observed assessment.
- Weak or absent SDEC, critical care, radiology, ED and community interface evidence.
- Historic procedures or competencies with no recent maintenance.
- Generic praise from referees rather than examples.
- Job documents that do not match the CV or show enough acute and GIM breadth.
A 90-day action plan before you submit
Before you spend months polishing documents, run a 90-day reality check. The aim is to discover whether your gaps are formatting gaps, evidence gaps or job-design gaps.
Acute Medicine Portfolio Pathway reset
Map the SSG
Build your evidence spreadsheet against every AIM specialty CiP, GIM clinical CiP, referee requirement and current-evidence rule.
Close obvious gaps
Book ACATs, request MCRs, collect SDEC examples, start missing feedback and locate audit or QI evidence.
Test job fit
If you cannot access acute take, SDEC, GIM supervision or meaningful consultant observation, the post may be the blocker.
Is your current Trust supportive enough?
This is where the recruitment question becomes legitimate. Acute Medicine Portfolio Pathway evidence is shaped by the service you work in. You need the right acute take exposure, SDEC, GIM supervision, senior observation, governance opportunities and consultants who are willing to write detailed reports.
BDI Consultants does not review Portfolio Pathway applications, sell mentorship or influence GMC or Royal College decisions. What we can do is help senior acute medicine doctors understand which NHS roles are more likely to give them the case mix, supervision and consultant-level responsibility they need while working towards the Specialist Register.
If your current job gives you the acute risk but not the observation, SDEC exposure, GIM sign-off or referees needed to evidence it, the next move may be strategic rather than impatient.
Sources
| Document | Publisher | |
|---|---|---|
| Portfolio pathway application guide | General Medical Council | |
| Specialty Specific Guidance for Portfolio pathway applications | General Medical Council | |
| Acute Internal Medicine with General Internal Medicine SSG | General Medical Council | |
| Curriculum for Acute Internal Medicine 2022 | JRCPTB / Federation of the Royal Colleges of Physicians | |
| Acute Internal Medicine specialty page | Federation of the Royal Colleges of Physicians | |
| Specialty Skills for the AIM Curriculum 2022 | General Medical Council / JRCPTB | |
| Good Medical Practice | General Medical Council | |
| Federation of Royal Colleges of Physicians | ePortfolio access for non-training doctors in physician specialties | View source |
Frequently asked
Is Acute Medicine Portfolio Pathway the same as Acute Internal Medicine?
Yes. The official GMC specialty guidance is for Acute Internal Medicine with General Internal Medicine. Doctors often search for Acute Medicine, but the Portfolio Pathway application is assessed against Acute Internal Medicine and the relevant General Internal Medicine or Internal Medicine learning outcomes.
Does Acute Internal Medicine Portfolio Pathway include General Internal Medicine?
Yes. The GMC SSG says the relevant high-level learning outcomes for General Internal Medicine are demonstrated by meeting the requirements in the Acute Internal Medicine guidance. Applicants also need to read the Acute Internal Medicine curriculum and the General Internal Medicine or Internal Medicine Stage 2 curriculum before building evidence.
What evidence matters most for Acute Medicine Portfolio Pathway?
The strongest evidence usually shows current independent practice across the acute unselected take, AMU leadership, same day emergency care, escalation decisions, specialist interfaces, discharge planning, GIM and a chosen specialty skill. It should include observed assessments, structured reports, feedback, audit or quality improvement, CPD and current clinical logs.
Do I need MRCP and the Acute Medicine SCE?
The GMC SSG refers to evidence of completion of MRCP(UK) or comparable assessment and evidence of completion of the Specialty Certificate Examination in Acute Internal Medicine or an equivalent. If you do not hold these, the SSG indicates that comparable knowledge evidence may need detailed mapping. Do not assume senior experience alone replaces knowledge evidence.
Can an overseas acute medicine consultant apply directly?
They can apply if eligible, but direct overseas applications are often harder because the SSG notes that NHS-style evidence such as MDT meetings, appraisal, multisource feedback, patient feedback, audit and quality improvement may not be covered in the same way outside the NHS. A UK senior post can make the evidence easier to build.
What should I collect first for Acute Medicine Portfolio Pathway?
Start with the live GMC SSG and build a gap map against generic CiPs, Internal Medicine clinical CiPs, Acute Internal Medicine specialty CiPs, structured reports, ACATs, MSF, patient survey, audit or QI and evidence of current consultant-level practice. Do not start by uploading everything you have.