Dual certification in Geriatric Medicine and GIM: what the evidence requirement actually means

Why Geriatric Medicine and GIM are one package in the Portfolio Pathway

When you complete a UK training programme in Geriatric Medicine and receive your Certificate of Completion of Training (CCT), you receive it in two specialties simultaneously: Geriatric Medicine and General Internal Medicine (GIM). That is the structure of the training programme. The Geriatric Medicine curriculum, published by the Joint Royal Colleges of Physicians Training Board (JRCPTB) in partnership with the British Geriatrics Society (BGS) and the Royal College of Physicians (RCP), is designed around a doctor who does both - a geriatrician who can take acute medical patients, run a general medical outpatient clinic, and manage the full range of medical admissions, not just patients identified as older adults or frail.

The Portfolio Pathway applies the same standard. If you apply for the Specialist Register in Geriatric Medicine via the Portfolio Pathway, you are assessed against a curriculum that includes both Geriatric Medicine and GIM outcomes. A successful application results in entry in both specialties. If the assessors find that your evidence demonstrates strong Geriatric Medicine practice but weak or absent GIM capability, the application will not succeed in either specialty - the two strands are assessed together, not independently.

This structure has significant practical implications for many of the doctors who are most likely to pursue the Geriatric Medicine Portfolio Pathway. Non-substantive Consultants and Specialty Doctors who have spent years working in rehabilitation, community geriatrics, care home support, or specialist frailty services will have built deep expertise in the geriatric-specific elements of the curriculum. But the further those years of practice have moved from acute take, general medical outpatient work, and the breadth of acute internal medicine, the harder it becomes to demonstrate the GIM strand convincingly.

There is an alternative: the GIM Portfolio Pathway, assessed under the separate GIM SSG, which results in Specialist Register entry in GIM only - not Geriatric Medicine. If your practice is closer to general acute internal medicine than to geriatric medicine, that may be the more appropriate route. But for most doctors who identify their practice primarily as geriatric medicine, the Geriatric Medicine SSG route is the right one, and it requires demonstrating both strands.

How the SSG handles two strands

The Specialty Specific Guidance (SSG) for Geriatric Medicine is the document that defines what assessors expect to see. It is published by JRCPTB and available through the GMC website. The SSG covers both the Geriatric Medicine outcomes and the GIM outcomes together, because the curriculum itself covers both. Applicants need to read the entire document carefully - the GIM requirements are not a separate appendix; they are woven through the main document alongside the Geriatric Medicine requirements.

The SSG sets out indicative minimum numbers for the key workplace-based assessments (WBAs) that form the evidence backbone of any JRCPTB application. For Geriatric Medicine Portfolio Pathway, these indicative numbers cover two distinct streams:

These numbers are indicative minimums published in the SSG, not a guarantee that meeting them will lead to a successful outcome. The SSG makes clear that the volume of evidence matters less than what the evidence demonstrates. A portfolio with eight GIM ACATs that all show the same patient type at the same clinical complexity tells assessors less than a portfolio with six ACATs that collectively demonstrate genuine breadth of acute medical presentations, decision-making under pressure, and independent consultant-level management across the spectrum of general internal medicine.

Always verify the current SSG figures directly before submitting. JRCPTB updates SSG documents periodically, and the indicative numbers above reflect the version current at the time of writing. If the figures in the current SSG differ, those override the figures here.

GIM evidence: the acute take requirement

The most commonly underweighted part of a Geriatric Medicine Portfolio Pathway application is the GIM acute take evidence. This is the strand that proves you can function as an independent Consultant Physician in acute general internal medicine - not just in geriatric medicine. Assessors want to see that if you were the medical registrar-equivalent on an acute take, you could manage the full range of acute medical presentations, not only frail older patients.

Acute take evidence for the GIM strand should ideally come from documented participation in an unselected medical take - nights, evenings, and weekends on a medical rota where the presenting conditions are not pre-selected for frailty or older adult presentation. An acute frailty unit rota counts, but assessors will look for whether the case mix demonstrates genuine general medicine breadth or whether it is limited to frailty-related conditions that overlap heavily with the geriatric strand.

GIM ACATs need to demonstrate independent decision-making at level 4 - "I could do this independently" across a range of presentations. A portfolio with six ACATs all from the same three-month acute take period, covering three patients with delirium, two with falls, and one with pneumonia, demonstrates neither sufficient volume nor sufficient breadth. Variety in the case types is not a bureaucratic tick-box; it is how assessors judge whether the GIM capability is genuinely consultant-level across the range that the specialty demands.

If you are currently in a post with limited or no acute take involvement, you face a practical challenge that needs a practical solution. Options include: negotiating regular acute medical sessions into your job plan even if your primary role is geriatric medicine; taking a locum or honorary attachment to a medical admissions unit; or building the case from hospital at home, rapid assessment clinic, and interface evidence combined with detailed documentation of the GIM cases you do encounter. The job plan flexibility article covers how to negotiate protected time for evidence-building activities, which is directly relevant here.

GIM evidence: outpatient and continuity care

The outpatient strand of GIM evidence (OPCATs) is distinct from the acute take strand. It requires evidence that you can manage a general internal medicine outpatient clinic - the sort of undifferentiated medical referrals that come to a general physician's clinic, not a specialist clinic focused on a single condition type.

For most geriatricians, the outpatient clinics they run are geriatric medicine-specific: memory clinics, falls clinics, frailty clinics, complex rehabilitation review clinics. These produce Geriatric Medicine OPCATs and are excellent evidence for the geriatric strand. What they do not produce is GIM OPCATs unless the patient mix and the clinical decision-making in the consultation genuinely map to general internal medicine breadth.

A patient seen in a memory clinic for cognitive assessment who also has poorly controlled hypertension, type 2 diabetes, and recently diagnosed atrial fibrillation - where the consultation involves active management decisions about all three conditions alongside the cognitive medicine work - can legitimately be documented as contributing to GIM evidence. The key is the documentation: the OPCAT must make clear that the clinical encounter involved decision-making across medical conditions outside the geriatric frame, not just the geriatric-specific presentation.

Continuity evidence - tracking a patient across multiple admissions and clinic appointments, showing evolving decision-making and the management of complex comorbidity over time - is also highly relevant to the GIM strand. Continuity is something geriatricians often do exceptionally well, precisely because older patients with complex multimorbidity tend to stay under the same consultant's care across different care settings. Documenting that continuity explicitly, mapping it to GIM curriculum outcomes, is a straightforward way to strengthen the GIM strand without requiring additional clinical sessions.

Geriatric Medicine-specific evidence

The Geriatric Medicine strand of the portfolio requires evidence that is genuinely specialty-specific - demonstrating capabilities that distinguish geriatric medicine practice from general medicine. This is the part of the portfolio that most geriatricians find more intuitive, because it reflects the clinical work they spend most of their time doing. The risk is assuming that because this evidence exists in abundance, it will speak for itself without careful packaging.

Assessors expect to see evidence across the full breadth of geriatric medicine practice, not just the most common presentations. The curriculum covers clinical areas that sit across multiple care settings - acute hospital, inpatient rehabilitation, community and care home medicine, specialist outpatient clinics, and end of life care. An applicant who can demonstrate depth in one setting (for example, an excellent acute frailty unit evidence base) but limited evidence of community geriatrics, care home medicine, or complex rehabilitation will not satisfy the full curriculum breadth requirement, even if the acute frailty evidence is strong.

The Comprehensive Geriatric Assessment (CGA) is central to the Geriatric Medicine strand. Evidence of CGA should come from multiple settings - acute CGA on the acute frailty unit or medical wards, elective CGA in outpatient and clinic environments, and CGA to support care home, community, or preoperative assessment work. A portfolio that demonstrates CGA in one setting only (for example, only in the acute frailty unit) satisfies the CGA competency but not necessarily the breadth of application that the curriculum expects.

Falls and bone health evidence deserves separate consideration. The falls curriculum is specific - it covers multifactorial falls risk assessment, the Falls and Fragility Fractures Audit Programme (FFFAP) standards, the identification and management of osteoporosis, fracture liaison services, and post-hip-fracture care including orthogeriatrics liaison. Simply having been involved in hip fracture management is not enough; the evidence needs to show structured falls risk thinking, investigation, and intervention.

Audit evidence for the geriatric strand should cover Geriatric Medicine-specific standards where possible - BGS best practice guidance, National Audit of Dementia, Fracture Liaison Service audit standards, NICE guidelines on falls, delirium, or frailty. A generic audit of antibiotic prescribing or handover quality demonstrates audit skill but does not demonstrate engagement with the clinical standards specific to Geriatric Medicine practice. Both strands need at least one closed-loop audit cycle that is current and well-documented.

MRCP and the Geriatric Medicine SCE

The knowledge evidence requirement for Geriatric Medicine Portfolio Pathway sits across both strands. For the GIM strand, the relevant knowledge examination is MRCP(UK) - the Membership of the Royal Colleges of Physicians of the United Kingdom. For the Geriatric Medicine strand, the relevant examination is the Geriatric Medicine Specialty Certificate Examination (SCE), which is a postgraduate examination that tests knowledge of Geriatric Medicine at the depth required for Consultant practice.

The SSG asks applicants to provide evidence of MRCP(UK) or a comparable qualification covering the breadth of general internal medicine. This is not a requirement to hold MRCP(UK) specifically - but for most applicants it is the strongest knowledge evidence available, and its absence creates a gap that needs to be filled by other means. The alternative to MRCP(UK) is typically a combination of: another knowledge examination covering internal medicine breadth; extensive CPD evidence with reflective entries mapped to GIM curriculum outcomes; and structured reports from referees who can speak specifically to the applicant's knowledge standard in general internal medicine.

The Geriatric Medicine SCE is a higher-level knowledge examination specific to the specialty. For Portfolio Pathway purposes, it serves as evidence of specialist knowledge in Geriatric Medicine, which is an important element of the geriatric strand of the curriculum. The BGS has noted that while the SCE may not be mandatory in every case - knowledge can be demonstrated through other means including structured CPD and evidence of clinical expertise - holding the SCE significantly strengthens the Geriatric Medicine-specific knowledge evidence in the portfolio. For most applicants who have the option to sit it, the SCE is worth taking before submitting.

Doctors who trained outside the UK may hold equivalent examinations - for example, specialist board certifications covering internal medicine or geriatric medicine from other jurisdictions. These can be acknowledged and considered, but the SSG will want to see evidence of how those qualifications map to the UK curriculum requirements. MRCP(UK) has a Part 1 and Part 2 that can be taken retrospectively even by established clinicians, and many internationally-trained doctors working in the UK have chosen this route precisely to strengthen the knowledge strand of their Portfolio Pathway application. See the overseas evidence article for more on how qualifications from other jurisdictions are treated.

CPD evidence has a role in knowledge demonstration for both strands. CPD records mapped explicitly to GIM curriculum outcomes - with reflective entries that demonstrate how the learning was applied in clinical practice - contribute meaningfully to the knowledge domain of the GIM strand. Generic conference attendance logs without reflection add volume but little weight. CPD entries that describe a specific clinical challenge encountered, the learning that was sought in response, and how practice changed as a result are substantially more persuasive than attendance certificates alone.

Structured reports for dual-certification applications

The structured reports for a Geriatric Medicine Portfolio Pathway application must cover both strands of the curriculum, not just the geriatric-specific elements. This has direct implications for who you choose as referees and how you brief them.

The SSG indicates a minimum of three structured reports. Those three reports collectively need to address: your Geriatric Medicine clinical capabilities (CGA, frailty, rehabilitation, community care, cognitive medicine); your GIM capabilities (acute take, breadth of internal medicine, outpatient general medicine); your research, audit, teaching, and leadership evidence; and your practice within the GMC's four domains. A referee who can only speak to your geriatric medicine work - because they have only seen you in a rehabilitation unit or care home setting - will leave the GIM strand partially unaddressed.

The practical implication is that your three referees should between them cover both your acute and non-acute practice. If your current role has limited acute take, one of your referees should ideally be from a previous period of acute practice, or from a setting where your GIM capabilities are observable. A current consultant colleague from the acute medical take, an educational supervisor who has observed both geriatric and general medicine work, and a third referee from a community or care home geriatrics context would give assessors a triangulated view of both strands. Three referees all from the same rehabilitation unit, however excellent your practice there, will not adequately cover the GIM strand of the assessment.

Briefing referees well is one of the highest-leverage things you can do before submitting. Referees who are not familiar with the Portfolio Pathway assessment process may write about character, reliability, and broad clinical skill in general terms that do not map to curriculum outcomes. Providing referees with the SSG, highlighting the GIM and Geriatric Medicine-specific capabilities that the structured report needs to address, and giving them a summary of the specific cases, clinics, and clinical contexts where they have observed you - all of this makes the difference between a structured report that advances your application and one that merely confirms you are a good doctor.

Common gaps and deferral triggers

Deferral requests in Geriatric Medicine Portfolio Pathway applications tend to cluster around predictable weaknesses. Understanding these before assembly begins is more useful than discovering them at the assessment stage.

What the right post looks like for a dual-certification application

For a doctor building a Geriatric Medicine Portfolio Pathway evidence base from scratch, or identifying significant gaps in an existing portfolio, the structure of the post matters considerably. The ideal post provides access to both strands of the curriculum simultaneously, not sequentially over several years in different roles.

For doctors currently in a post that provides only one strand convincingly, the practical question is whether a role change is more efficient than trying to bolt on evidence-building activities to a post that structurally limits what can be evidenced. This is not always a comfortable calculation. If you are in a comfortable, well-established community geriatrics role with no realistic route to acute take sessions and no general medicine outpatient commitment, the GIM strand of your Portfolio Pathway application will remain weak until either the job plan changes or the post does.

The Portfolio Pathway-supportive Trust article covers what to look for in a Trust and post that provides the structural support for a successful application. For Geriatric Medicine in particular, the key question to ask of any prospective post is not just "do you do geriatric medicine?" but "is there a route to acute take involvement and general medical outpatient work within this or an affiliated role?" A Trust that has an active acute medicine service alongside its geriatric medicine provision, and that is willing to support dual-strand evidence-building through a structured job plan, is significantly more useful than one where geriatric medicine is entirely separated from general medicine activity.

For the full picture on the GMC fees and application costs and a realistic view of the timeline to submission, those articles cover both in detail. The GMC statutory fee for a Portfolio Pathway application changes annually; always verify the current figure directly with the GMC rather than relying on figures quoted in other resources.

All 18 specialisms

Geriatric Medicine and GIM share a curriculum. The remaining specialisms in this series each have their own SSG and their own application structure. All 18 specialisms are linked below.