For General Internal Medicine, the Portfolio Pathway is about proving broad independent internal medicine practice. The GMC SSG expects evidence across acute unselected take, outpatient or ambulatory care, inpatient continuity, referrals from other specialties, MDT discharge planning, resuscitation and end of life care. The risk is narrow evidence that looks senior but does not cover the curriculum.
What makes GIM different?
What assessors are really testing
The GMC's General Internal Medicine Specialty Specific Guidance is clear that the document is not standalone. It must be read with the General Internal Medicine or Internal Medicine Stage 2 curriculum. That matters because the assessors are not just checking whether you have held a senior medical job. They are checking whether your evidence covers the full scope of the curriculum.
The centre of the application is breadth. GIM requires diagnostic reasoning, management of uncertainty, comorbidity, acute deterioration, long term conditions, interface work with other specialties, discharge planning, palliative care decisions, leadership and NHS systems. A strong application makes that breadth visible.
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.
The title is not the evidence
A fixed-term Consultant, Specialist Grade or senior SAS title may help explain your role, but it does not prove GIM capability. The portfolio needs current, triangulated evidence that other consultants have observed you doing the work independently across the GIM curriculum.
GIM vs Internal Medicine Stage 2
The naming is confusing. The GMC SSG is titled General Internal Medicine, while the current training framework is Internal Medicine Stage 2. In practical Portfolio Pathway terms, do not waste energy on the naming. Use the live GMC SSG and map your evidence to the Internal Medicine Stage 2 curriculum outcomes.
The Federation says Internal Medicine Stage 2 replaced current General Internal Medicine training from August 2022. The curriculum purpose is to define the capabilities needed for successful completion of Internal Medicine. That is the standard your evidence is being tested against.
The GIM CiPs you have to make visible
The Internal Medicine curriculum is built around generic and clinical Capabilities in Practice (CiPs). A GIM Portfolio Pathway applicant needs evidence that shows unsupervised capability across the clinical tasks, not just one high-volume setting.
Acute unselected take
Prioritisation, risk assessment, team leadership, diagnostic reasoning and safe first opinion across a broad acute medical case mix.
Acute specialty service care
Managing acute medical problems within specialty services and knowing when specialist input should change the plan.
Inpatient continuity
Ongoing care for medical inpatients, including comorbidity, cognitive impairment, escalation and safe handover.
Outpatient and ambulatory care
Clinics, ambulatory pathways, long term condition management, shared decision making and follow-up planning.
Medical problems in other specialties
Referral work, perioperative medicine, surgical liaison, obstetric or psychiatric interface cases where relevant.
MDT and discharge planning
Working across nursing, therapy, pharmacy, social care and community teams to manage complex discharge safely.
Resuscitation and deterioration
Leading deterioration management, CPR team work, escalation decisions and treatment limitation discussions.
End of life and palliative care
Symptom control, communication with families, realistic care planning and recognition of dying.
The SSG evidence numbers that matter
This is where GIM gets very practical. The SSG gives indicative minimum numbers for several assessment types. These are not a licence to submit thin evidence once the number is hit. They are a floor for building a balanced, current, curriculum-mapped application.
Indicative GIM evidence expectations
Use this as a planning tool, then check the live SSG before submission.
Procedures, DOPS and practical skills
GIM has a practical procedures section. The SSG says evidence can be provided using logbooks and Direct Observation of Procedural Skills (DOPS). It also says a structured report concentrating on core GIM procedural skills can be used, but that means choosing a referee who has directly observed the relevant work.
Core Internal Medicine procedures named in the SSG
Separate the procedures requiring unsupervised competence from those where skills lab or supervised practice may be acceptable.
Non-training doctors in physician specialties can use Federation/JRCPTB ePortfolio access to collect recognisable physician assessments. For GIM, that can make ACATs, OPCATs, CbDs, mini-CEX, DOPS and Multiple Consultant Reports easier to organise in a format assessors understand.
Evidence your post must generate
Some GIM evidence is impossible to manufacture at the end. It has to come from the post itself. The SSG asks for employment letters that match the CV, job descriptions, rota samples from the last three years, appraisal or performance review evidence and proof of ongoing evaluation in non-training posts.
The GIM job-fit evidence checklist
These are the documents and opportunities the job itself needs to produce. If they are difficult to obtain, the post may be slowing the Portfolio Pathway down.
Interface work and breadth
GIM assessors are looking for the doctor who can make safe first-opinion decisions across the hospital, not just the doctor who is excellent in one ward environment. Your evidence should include work at the edge of services.
The GIM breadth map
The strongest applications show GIM work across the edges of the hospital, not just one ward or one type of patient.
Unselected medicine
ACATs, take lists, consultant-observed prioritisation and reflections on uncertainty.
Continuity and comorbidity
Ward rounds, complex reviews, cognitive impairment, polypharmacy and escalation planning.
Clinic and same-day pathways
OPCATs, clinic letters, ambulatory protocols and shared decision making.
Referral medicine
Surgical liaison, perioperative medicine, obstetric interface, psychiatry interface or specialty ward reviews where relevant.
Discharge planning
Therapy, pharmacy, social care and community coordination for medically complex patients.
Resuscitation and ceiling of care
CPR leadership, escalation, critical care discussions and treatment limitation planning.
Common gaps in GIM applications
Broad, current and observed
- ACATs and MCRs from consultants who have seen the acute take work.
- Rotas showing non-clinical time, acute duties, clinic or ambulatory sessions and ward responsibility.
- Procedure evidence that maps directly to the GIM list.
- Patient and colleague feedback with reflection and action.
Senior but narrow
- Strong ward work but little acute unselected take evidence.
- Clinic letters without OPCAT or consultant-observed assessment.
- Procedure logbook with no DOPS or senior confirmation.
- Generic structured reports that say excellent doctor but do not map to CiPs.
A 90-day GIM evidence reset
If you are already doing GIM-level work, the first task is not to write the application. It is to make the next three months produce better evidence than the last three years.
Map the SSG
Build a table against each CiP, ACAT, OPCAT, SLE, DOPS, MCR, MSF, patient survey and employment-document requirement.
Fix observation
Book consultant observation for ACATs, clinic assessments, procedures and the MCRs you will need in the next 12 months.
Capture breadth
Collect evidence from take, ward continuity, clinic, referrals, discharge planning, deterioration and end of life care.
Review the job fit
Check whether your current post can continue producing evidence or whether you need a more supportive role.
Download the GIM evidence map
A 2-page worksheet for mapping ACATs, OPCATs, procedures, MSF, patient feedback, MCRs, rota proof and job-fit gaps against the GIM SSG.
The supportive Trust test
A supportive GIM post is not simply one where the department says they like Portfolio Pathway. It is one where the work pattern produces the evidence. You need consultant observation, rota samples, appraisal, governance involvement, acute take exposure, clinic or ambulatory work, referral work, MDT involvement and senior colleagues willing to complete useful reports.
That is where job choice matters. If your current role gives you service pressure but not observed practice, appraisals, assessment access or curriculum breadth, it may slow the application even if you are clinically strong.
Sources
| Document | Publisher |
|---|---|
| General Internal Medicine Specialty Specific Guidance | General Medical Council |
| General Internal Medicine / Internal Medicine Stage 2 curriculum 2022 | General Medical Council |
| Specialty Specific Guidance library | General Medical Council |
| Portfolio Pathway application guide | General Medical Council |
| Internal Medicine specialty page | Federation of Royal Colleges of Physicians |
| ePortfolio access | Federation of Royal Colleges of Physicians |
| Good Medical Practice | General Medical Council |
FAQs
Is General Internal Medicine the same as Internal Medicine Stage 2?
For current training and assessment purposes, the modern curriculum is Internal Medicine Stage 2. The GMC Specialty Specific Guidance is still titled General Internal Medicine and should be read with the General Internal Medicine or Internal Medicine Stage 2 curriculum. The practical point is that applicants need evidence across the broad internal medicine curriculum, not only one narrow ward, clinic or subspecialty workload.
What is the biggest evidence risk in a GIM Portfolio Pathway application?
The biggest risk is narrow evidence. General Internal Medicine requires breadth across acute unselected take, inpatient continuity, outpatient or ambulatory care, medical problems in other specialties, multidisciplinary discharge planning, deterioration and end of life care. A senior title alone is not enough if the portfolio does not show broad, current, consultant-level internal medicine practice.
How many ACATs are expected for GIM Portfolio Pathway?
The GMC General Internal Medicine SSG gives an indicative minimum of six ACATs showing independent performance at entrustment level 4. Each ACAT should include at least five cases and should normally be undertaken with a consultant. They are used to assess performance on take, presenting new patients on ward rounds, prioritisation and working with the team.
Do I need procedure evidence for General Internal Medicine?
Yes. The GIM SSG includes internal medicine procedures and says evidence can be provided using logbooks and DOPS. For some procedures applicants must show unsupervised competence. For others, skills lab training or satisfactory supervised practice may be acceptable. A structured report from a senior GIM doctor can also be important where it directly comments on procedural competence.
Can overseas doctors apply directly for GIM Portfolio Pathway?
They can apply if they meet the GMC rules, but direct-from-overseas applications are harder in practice. The GMC notes that NHS features such as multidisciplinary working, governance, appraisal, patient feedback, rotas and UK-style workplace assessments may be difficult to evidence from outside the NHS. Most internationally trained doctors build a stronger portfolio after working in a suitable UK post.
What type of NHS post helps a GIM Portfolio Pathway application?
A useful post gives you breadth and evidence. Look for work that includes acute unselected take, inpatient responsibility, clinic or ambulatory exposure, referrals from other specialties, deterioration and resuscitation work, discharge planning, governance, appraisal, teaching and consultant observation. The job must produce evidence, not just experience.