Neurology 2022 Curriculum FINAL July 2022 v1.0

Curriculum for Neurology Training
Implementation August 2022

Contents
1 Introduction ................................................................................................................................ 3
2 Purpose of the curriculum .......................................................................................................... 4
2.1 High level learning outcomes – Capabilities in Practice (CiPs) ............................................... 5

2.2 Training pathway ..................................................................................................................... 7
2.3 Duration of training .................................................................................................................. 7
2.4 Flexibility and accreditation of transferable capabilities .......................................................... 8
2.5 Less than full time training ....................................................................................................... 8
2.6 Generic Professional Capabilities (GPC) and Good Medical Practice (GMP) ........................ 9
3 Content of Learning.................................................................................................................. 10
3.1 Capabilities in Practice .......................................................................................................... 10
3.2 Generic Capabilities in Practice ............................................................................................. 11
3.3 Clinical Capabilities in Practice .............................................................................................. 16
3.4 Specialty Capabilities in Practice ........................................................................................... 22
3.5 Presentations and conditions ................................................................................................ 35
3.6 Practical procedures .............................................................................................................. 44
4 Learning and Teaching ............................................................................................................ 45
4.1 The training programme ........................................................................................................ 45
4.2 Teaching and learning methods ............................................................................................ 46
4.3 Academic training .................................................................................................................. 49
4.4 Taking time Out Of Programme (OOP) ................................................................................. 49
4.5 Acting up as a consultant....................................................................................................... 49
5 Programme of Assessment ...................................................................................................... 50
5.1 Purpose of assessment ......................................................................................................... 50
5.2 Programme of Assessment ................................................................................................... 50
5.3 Assessment of Capabilities in Practice (CiPs) ...................................................................... 51
5.4 Critical progression points ..................................................................................................... 52
5.5 Evidence of progress ............................................................................................................. 56
5.6 Decisions on progress (ARCP) .............................................................................................. 59
5.7 Assessment blueprint ............................................................................................................ 60
6 Supervision and feedback ........................................................................................................ 62
6.1 Supervision ............................................................................................................................ 63
6.2 Appraisal ................................................................................................................................ 64
7 Quality Management ................................................................................................................ 65
8 Intended use of curriculum by trainers and trainees ................................................................ 66
9 Equality and Diversity............................................................................................................... 67
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Neurology Specialty Curriculum 2022
An application has been made to change the name of the specialty General Internal
Medicine (GIM) to Internal Medicine (IM). These terms are used interchangeably in this
document except where there is direct reference to the Certificate of Completion of Training
(CCT). The curriculum will be referred to as GIM/IM stage 2.
1. Introduction
The burden of neurological disease in the United Kingdom is high and increasing. 12.2
million people in the United Kingdom live with a neurological disorder. One million are
disabled by their condition, 350 000 of whom require help with activities of daily living. For
2.2 million, their condition worsens over time and for 7.4 million their deficits are
intermittent (1).
In a patient survey published in 2019 (2), one in three patients waited over a year to see a
neurologist and only 30% of patients felt involved in decision making about their care. The
prevalence of neurological disease and the capricious nature of many of the conditions
explains the associated 700,000 emergency admissions and 11 million bed-days each year.
The very serious nature of these diseases is also reflected in the increasing mortality rate
associated with neurological conditions in the UK, in contrast to all-cause mortality (3).
It is also of relevance that in the most recent WHO International Classification of Disease
(ICD-11) stroke has been classified as a neurological disease, rather than a cardiovascular
disease (4). This is of particular importance to patients who live with neurological disability
after a stroke, the nature of which is the same or very similar to that caused by other
diseases involving the brain.
The reforms associated with Shape of Training coupled with the needs of patients with
neurological disease led the Neurology Specialist Advisory Committee (SAC) of the JRCPTB
and the Association of British Neurologists (ABN) and the Association of British Neurologists
Trainees (ABNT) to engage with the neurology community to determine how training in
neurology should change to develop neurology consultants who can deliver the highest
quality patient care.
This revision of the neurology curriculum reflects this burden of disease but also the
dramatic developments in the diagnosis and management of acute and chronic neurological
diseases to ensure patients, their families, and the doctors providing their care, are well
served by neurology training in the future.
In the reforms of Shape of Training, neurology is joining the other major specialties in Group
1, incorporating into specialist training an additional year of internal medicine.
Furthermore, the neurology curriculum will incorporate the three capabilities described in
the new stroke curriculum, which will be necessary for doctors to contribute to the care of
stroke patients.
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2. Purpose of the curriculum
2.1 Purpose of the curriculum
The curriculum will outline the training required for neurologists to deal with the growing
number of people with neurological diseases that can be treated and require long-term
management, and those who present acutely to neurology, stroke, and general medical
services.
This curriculum will ensure that trainees acquire the necessary capabilities by describing the
skills and knowledge required at each stage of training, and indicate the likely duration of
training in neurology, stroke and specialist clinical areas of the neurology curriculum. The
curriculum will also describe the assessment tools (mini-CEX, CbD and MSF) to be used, to
ensure that trainees acquire the necessary capabilities.
The curriculum will reflect the demand for trained neurologists in three distinct areas of
practice: acute (including inpatients), outpatients, and ambulatory care.
The demands on acute neurology services are increasing in two contrasting areas: the acute
general neurology and stroke services in secondary care, and the tertiary neurology services
that deliver state-of-the-art complex treatment (which may also include stroke). As
treatments for acute neurological diseases (particularly stroke) are so time critical, it seems
highly likely that neurologists, who will be dual-trained in internal medicine, will be asked to
take on more acute work, to help develop services which are focused on the acute
presentations of all conditions involving the nervous system. The skills and knowledge
required will be reflected in the new curriculum.
Currently the vast majority of people with neurological diseases present to Neurologists as
outpatients. The breadth and complexity of neurological diseases means that periods of
dedicated outpatient training in specialist clinical areas of neurology are of the utmost
importance. As well as the more common diseases which now have complex treatments,
there are many rare immune-mediated, paraneoplastic, infectious and metabolic diseases
for which a delay in diagnosis can have profound implications.
The assessment and management of chronic disability is often best done in the community
where an assessment of the patient can be combined with an evaluation of their
psychosocial predicament, their environment and the suitability of their accommodation. In
addition, there are many conditions that lend themselves to assessment in ambulatory care
units and community clinics, including chronic headache, pain, Parkinson’s disease and
secondary progressive Multiple Sclerosis, to name just a few. The broad range of
neurological and general medical training in the new curriculum will make neurologists of
the future particularly well suited to work in the community.
The curriculum also needs to reflect the organisational skills needed to work effectively with
colleagues from different specialties and allied healthcare professionals in order to run
efficient patient-centred ambulatory care services.
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Specialty training in Neurology will begin following completion of the Internal Medicine
Stage 1 curriculum. Training will be provided in a variety of settings using a range of
methods including workplace-based experiential learning, formal postgraduate teaching and
simulation-based education.
There are a range of ways a trainee can meet an outcome, one of which may be
attendance at a relevant course. Attendance at courses in locations across the United
Kingdom, two or three each year tailored to the training requirements (neurology, stroke,
internal medicine) of the doctor, will be an important part of training. Attendance at
national or supra-regional general meetings (such as those of the Association of British
Neurologists) are recommended as one of the ways in which learning outcomes can be
demonstrated to ensure the trainee’s engagement with important advances in research,
clinical practice and in the management of complex ethical and legal matters. No subject-
specific courses will be a mandatory requirement of the curriculum but attendance at two
courses every year is proposed to ensure that training is completed in specialist areas of
the neurology curriculum. Existing methods of assessment will be used to assess the effect
of courses on a trainee’s progress, including Case Based Discussions, Teaching
Observations (in which highlights from courses are passed on in departmental teaching
sessions), the Specialty Specific Exam, and reflections on courses as assessed by the
Educational Supervisor.
The purpose statement for this curriculum has been endorsed by the GMC’s Curriculum
Oversight Group (COG) and was commended as meeting the needs of the health services of
the countries of the UK.
2.2 High level learning outcomes – Capabilities in Practice (CiPs)
The specialty CiPs incorporate the core capabilities that all trainees must achieve in order to
practice as a general neurologist in an acute (including inpatients), outpatient and
ambulatory setting. Each neurology CiP refers to a group of neurological disorders with a
combined estimated prevalence of more than 100,000 in the UK.
Following the successful completion of a training programme in neurology, a doctor will be

able to do the following:
• Provide inpatient and outpatient services for patients presenting with neurological
conditions, including stroke.
• Appropriately request and interpret diagnostic tests including structural and
functional imaging techniques, neurophysiology, histopathology and gene analysis.
• Interpret psychological and neurological symptoms, including psychiatric
complications of neurological disease and presentations with functional
neurological symptoms.
• Work effectively with colleagues in allied medical specialties such as clinical
genetics, neurosurgery, neuroradiology, neurorehabilitation, ophthalmology and
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audiovestibular medicine and with professions allied to medicine such as
physiotherapy, occupational therapy, speech and language therapy and
psychology.
• Constructively engage with national, regional and local organisations in planning
the management and prevention of neurological disease.
• Engage with university employees to promote academia and high quality research
Learning outcomes – Capabilities in Practice (CiPs)

Generic CiPs
1. Able to successfully function within NHS organisational and management systems
2. Able to deal with ethical and legal issues related to clinical practice
3. Communicates effectively and is able to share decision making, while maintaining
appropriate situational awareness, professional behaviour and professional
judgement
4. Is focused on patient safety and delivers effective quality improvement in patient care
5. Carrying out research and managing data appropriately
6. Acting as a clinical teacher and clinical supervisor
Clinical CiPs (Internal Medicine)

1. Managing an acute unselected take
2. Managing the acute care of patients within a medical specialty service
3. Providing continuity of care to medical inpatients, including management of
comorbidities and cognitive impairment
4. Managing patients in an outpatient clinic, ambulatory or community setting, including
management of long term conditions
5. Managing medical problems in patients in other specialties and special cases
6. Managing a multidisciplinary team including effective discharge planning
7. Delivering effective resuscitation and managing the acutely deteriorating patient
8. Managing end of life and applying palliative care skills
Neurology Specialty CiPs
1. Managing disorders of cognition and consciousness
2. Managing headache and pain
3. Managing seizures and epilepsy
4. Managing inflammatory and infectious disorders
5. Managing movement disorders
6. Managing neuromuscular disorders
7. Managing traumatic brain injury and patients requiring neurorehabilitation
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8. Managing neuropsychiatric disorders, and functional neurological disorders
Stroke Sub-specialty CiPs
1. Managing the care of acute stroke patients, including hyperacute care and cerebral
reperfusion strategies.
2. Managing the primary and secondary prevention of stroke and Transient Ischaemic
Attack
3. Managing early and late stroke rehabilitation in hospital and community settings
2.3 Training pathway
Training starts with stage 1 Internal Medicine Training (IMT), during which there will be a
gradually increasing responsibility for the acute medical take, and during which the
MRCP(UK) Diploma should be attained.
There will then be competitive entry into specialty training during which the Internal
Medicine Stage 2 curriculum will be completed with an indicative duration of training of
twelve months, three months of which will be in the final year of training, although
depending on the rate of progression and acquisition of capabilities this may be longer, or
shorter, for some trainees.
2.4 Duration of training
The new curriculum, with dual training in neurology and internal medicine and sub-specialty
accreditation in stroke medicine will be organised over five years of training. As with other
group 1 specialties, training in Neurology will comprise an indicative 3 years of IM Stage 1
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followed by competitive selection for entry into specialist training. This will be followed by 5
years of specialty training incorporating IM Stage 2 and Stroke Medicine training.
There will be options for those trainees who demonstrate exceptionally rapid development
and acquisition of capabilities to complete training more rapidly than the current indicative
time although it is recognised that clinical experience is a fundamental aspect of
development as a good physician (guidance on completing training early will be available on
the JRCPTB website). There is also likely to be a number of trainees who for a number of
different possible reasons will require an extension of training in accordance with the
Reference Guide for Postgraduate Specialty Training in the UK (5)
2.5 Flexibility and accreditation of transferable capabilities
The curriculum incorporates and emphasises the importance of the Generic Professional
Capabilities (GPCs). GPCs will promote flexibility in postgraduate training as these common
capabilities can be transferred from specialty to specialty. In addition, the IM generic CiPs
will be shared across all physicianly curricula and the IM clinical CiPs will be shared across all
group 1 specialities, supporting flexibility for trainees to move between these specialties
without needing to repeat all aspects of training. The curriculum supports the accreditation
of transferable competencies (using the Academy framework).
The curriculum will allow trainees to train in academic medicine alongside their acquisition
of clinical and generic capabilities, and these skills will be transferable across other
specialties. Notwithstanding the fact that completion of the curriculum is based on the
acquisition of capabilities there is no expectation that academic trainees will be able to
complete the curriculum in a shorter clinical training programme, particularly as capabilities
in internal medicine and stroke will be compulsory for completion of training.
The frequency with which internal medicine problems manifest in the nervous system
suggests that a period of training in neurology will lead to the acquisition of valuable and
easily transferable skills in internal medicine
Finally, the frequency with which neurological problems occur in diseases of the heart,
kidney, liver and lungs, either as a complication of the disease or of the treatment, means
that skills learnt in neurology training will be of relevance to training in each of the major
specialties, particularly the other Group 1 specialties.
2.6 Less than full time training (LTFT)
Trainees are entitled to opt for less than full time training programmes. Less than full time
trainees should undertake a pro rata share of the out-of-hours duties (including on-call and
other out-of-hours commitments) required of their full-time colleagues in the same
programme and at the equivalent stage.
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Less than full time trainees should assume that their clinical training will be of a duration
pro-rata with the time indicated/recommended, but this should be reviewed in accordance
with the Gold Guide.
2.6 Generic Professional Capabilities (GPCs) and Good Medical Practice (GMP)
The GMC has developed the Generic Professional Capabilities (GPC) framework (6) with the
Academy of Medical Royal Colleges (AoMRC) to describe the fundamental, career-long,
generic capabilities required of every doctor. The framework describes the requirement to
develop and maintain key professional values and behaviours, knowledge, and skills, using a
common language. GPCs also represent a system-wide, regulatory response to the most
common contemporary concerns about patient safety and fitness to practise within the
medical profession. The framework will be relevant at all stages of medical education,
training and practice.
Good Medical Practice (GMP,7) is embedded at the heart of the GPC framework. In
describing the principles, duties and responsibilities of doctors the GPC framework
articulates GMP as a series of achievable educational outcomes to enable curriculum design
and assessment.
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The GPC framework describes nine domains with associated descriptor outlining the
‘minimum common regulatory requirement’ of performance and professional behaviour for
those completing a CCT or its equivalent. These attributes are common, minimum and
generic standards expected of all medical practitioners achieving a CCT or its equivalent.
The nine domains and subsections of the GPC framework are directly identifiable in the IM
curriculum. They are mapped to each of the generic and clinical CiPs, which are in turn
mapped to the assessment blueprints. This is to emphasise those core professional
capabilities that are essential to safe clinical practice and that they must be demonstrated at
every stage of training as part of the holistic development of responsible professionals.
This approach will allow early detection of issues most likely to be associated with fitness to
practise and to minimise the possibility that any deficits are identified only during the final
phases of training.
3 Content of Learning
The curriculum is spiral, and topics and themes will be revisited to expand understanding
and expertise. The level of entrustment for capabilities in practice (CiPs) will increase as an
individual progresses from needing direct supervision to being entrusted to act without
supervision.
3.1 Capabilities in Practice (CiPs)
CiPs describe the professional tasks or work within the scope of the specialty and internal
medicine. CiPs are based on the concept of entrustable professional activities (8) which use
the professional judgement of appropriately trained, expert assessors as a defensible way of
forming global judgements of professional performance.
Each CiP has a set of descriptors associated with that activity or task. Descriptors are
intended to help trainees and trainers recognise the knowledge, skills and attitudes which
should be demonstrated. Doctors in training may use these capabilities to provide evidence
of how their performance meets or exceeds the minimum expected level of performance
for their year of training. The descriptors are not a comprehensive list and there are many
more examples that would provide equally valid evidence of performance.
Many of the CiP-descriptors refer to patient-centred care and shared decision making. This
is to emphasise the importance of patients being at the centre of decisions about their own
treatment and care, by exploring care or treatment options and their risks and benefits and
discussing choices available.
Additionally, the clinical CiPs repeatedly refer to the need to demonstrate professional
behaviour with regards to patients, carers, colleagues and others. Good doctors work in
partnership with patients and respect their rights to privacy and dignity. They treat each
patient as an individual. They do their best to make sure all patients receive good care and
treatment that will support them to live as well as possible, whatever their illness or
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disability. Appropriate professional behaviour should reflect the principles of GMP and the
GPC framework.
In order to complete training and be recommended to the GMC for the award of a CCT and
entry to the specialist register, the doctor must demonstrate that they are capable of
unsupervised practice in all generic and clinical CiPs. Once a trainee has achieved level 4 sign
off for a CiP it will not be necessary to repeat assessment of that CiP if capability is
maintained (in line with standard professional conduct).
This section of the curriculum gives details of the six generic CiPs, eight clinical CiPs for
internal medicine (stage 2), eight specialty CiPs for Neurology and three CiPs for Stroke
Medicine. The expected levels of performance, mapping to relevant GPCs and the evidence
that may be used to make an entrustment decision are given for each CiP. The list of
evidence for each CiP is not prescriptive and other types of evidence may be equally valid
for that CiP.
3.2 Generic Capabilities in Practice
The six generic CiPs cover the universal requirements of all specialties as described in GMP
and the GPC framework. Assessment of the generic CiPs will be underpinned by the
descriptors for the nine GPC domains and evidenced against the performance and
behaviour expected at that stage of training. Satisfactory sign off will indicate that there are
no concerns. It will not be necessary to assign a level of supervision for these non-clinical
CiPs.
In order to ensure consistency and transferability, the generic CiPs have been grouped
under the GMP-aligned categories used in the Foundation Programme curriculum plus an
additional category for wider professional practice:
• Professional behaviour and trust

• Communication, team-working and leadership
• Safety and quality
• Wider professional practice
For each generic CiP there is a set of descriptors of the observable skills and behaviours
which would demonstrate that a trainee has met the minimum level expected. The
descriptors are not a comprehensive list and there may be more examples that would
provide equally valid evidence of performance.
Assessment tools
ACAT Acute care assessment tool ALS Advanced Life Support

CbD Case-based discussion DOPS Direct observation of procedural skills
GCP Good Clinical Practice Audit Audit Assessment
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Mini-CEX Mini-clinical evaluation MCR Multiple consultant report
exercise
MSF Multi source feedback PS Patient survey
QIPAT Quality improvement TO Teaching observation
project assessment tool
Generic capabilities in practice (CiPs)
Category 1: Professional behaviour and trust

1. Able to function successfully within NHS organisational and management systems
Descriptors • Aware of and adheres to the GMC professional requirements

• Aware of public health issues including population health, social
detriments of health and global health perspectives
• Demonstrates effective clinical leadership
• Demonstrates promotion of an open and transparent culture
• Keeps practice up to date through learning and teaching
• Demonstrates engagement in career planning
• Demonstrates capabilities in dealing with complexity and uncertainty
• Aware of the role of and processes for operational structures within
the NHS
• Aware of the need to use resources wisely
GPCs Domain 1: Professional values and behaviours
Domain 3: Professional knowledge
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries
Domain 9: Capabilities in research and scholarship
Evidence to MCR
inform MSF
decision Active role in governance structures
Management course
End of placement reports
2. Able to deal with ethical and legal issues related to clinical practice
Descriptors • Aware of national legislation and legal responsibilities, including

safeguarding vulnerable groups
• Behaves in accordance with ethical and legal requirements
• Demonstrates ability to offer apology or explanation when
appropriate
• Demonstrates ability to lead the clinical team in ensuring that
medical legal factors are considered openly and consistently
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GPCs Domain 3: Professional knowledge
Domain 4: Capabilities in health promotion and illness prevention
Domain 7: Capabilities in safeguarding vulnerable groups
Domain 8: Capabilities in education and training
Evidence to MCR
inform MSF
decision CbD
DOPS
Mini-CEX
ALS certificate
End of life care and capacity assessment
Category 2: Communication, teamworking and leadership
3. Communicates effectively and is able to share decision making, while maintaining
appropriate situational awareness, professional behaviour and professional
judgement
Descriptors • Communicates clearly with patients and carers in a variety of settings
• Communicates effectively with clinical and other professional
colleagues
• Identifies and manages barriers to communication (eg cognitive
impairment, speech and hearing problems, capacity issues)
• Demonstrates effective consultation skills including effective verbal
and nonverbal interpersonal skills
• Shares decision making by informing the patient, prioritising the
patient’s wishes, and respecting the patient’s beliefs, concerns and
expectations
• Shares decision making with children and young people
• Applies management and team working skills appropriately, including
influencing, negotiating, re-assessing priorities and effectively
managing complex, dynamic situations
GPCs Domain 2: Professional skills
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management;
consent; humane interventions; prescribing medicines safely;
using medical devices safely; infection control and communicable
disease)
Domain 5: Capabilities in leadership and teamworking
Evidence to MCR
inform MSF
decision PS
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Category 3: Safety and quality

4. Is focused on patient safety and delivers effective quality improvement in patient
care
Descriptors • Makes patient safety a priority in clinical practice
• Raises and escalates concerns where there is an issue with patient
safety or quality of care
• Demonstrates commitment to learning from patient safety
investigations and complaints
• Shares good practice appropriately
• Contributes to and delivers quality improvement
• Understands basic Human Factors principles and practice at individual,
team, organisational and system levels
• Understands the importance of non-technical skills and crisis resource
management
• Recognises and works within limit of personal competence
• Avoids organising unnecessary investigations or prescribing poorly
evidenced treatments
Domain 2: Professional skills
consent; humane interventions; prescribing medicines safely; using
medical devices safely; infection control and communicable
disease)
Domain 6: Capabilities in patient safety and quality improvement
• patient safety
• quality improvement
Evidence to MCR
inform MSF
decision QIPAT
Category 4: Wider professional practice
5. Carrying out research and managing data appropriately
Descriptors • Manages clinical information/data appropriately

• Understands principles of research and academic writing
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• Demonstrates ability to carry out critical appraisal of the literature
• Understands the role of evidence in clinical practice and demonstrates
shared decision making with patients
• Demonstrates appropriate knowledge of research methods, including
qualitative and quantitative approaches in scientific enquiry
• Demonstrates appropriate knowledge of research principles and
concepts and the translation of research into practice
• Follows guidelines on ethical conduct in research and consent for
research
• Understands public health epidemiology and global health patterns
• Recognises potential of applied informatics, genomics, stratified risk
and personalised medicine and seeks advice for patient benefit when
appropriate
GPCs Domain 3: Professional knowledge
Evidence to MCR
inform MSF
decision GCP certificate (if involved in clinical research)
Evidence of literature search and critical appraisal of research
Use of clinical guidelines
Quality improvement and audit
Evidence of research activity
6. Acting as a clinical teacher and clinical supervisor
Descriptors • Delivers effective teaching and training to medical students, junior

doctors and other health care professionals
• Delivers effective feedback with action plan
• Able to supervise less experienced trainees in their clinical assessment
and management of patients
• Able to supervise less experienced trainees in carrying out appropriate
practical procedures
• Able to act a clinical supervisor to doctors in earlier stages of training
Evidence to MCR
inform MSF
decision TO
Relevant training course
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3.3 Clinical Capabilities in Practice (CiPs)
The eight IM clinical CiPs describe the clinical tasks or activities which are essential to the
practice of Internal Medicine. The clinical CiPs have been mapped to the nine GPC domains
to reflect the professional generic capabilities required to undertake the clinical tasks.
Satisfactory sign off will require educational supervisors to make entrustment decisions on
the level of supervision required for each CiP and if this is satisfactory for the stage of
training, the trainee can progress. More detail is provided in the programme of assessment
section of the curriculum.
Clinical CiPs – Internal Medicine
Descriptors • Demonstrates professional behaviour with regard to patients, carers,

colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns,
priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and
psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking
into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management
decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Recognises need to liaise with specialty services and refers where
appropriate
clinical skills (history taking, diagnosis and medical management;
disease)
• national legislation
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• patient safety
Evidence to MCR
inform MSF
decision CbD
ACAT
Logbook of cases
Simulation training with assessment
2. Managing the acute care of patients within a medical specialty service
Descriptors • Able to manage patients who have been referred acutely to a

specialised medical service as opposed to the acute unselected take (eg
cardiology and respiratory medicine acute admissions
• Demonstrates professional behaviour with regard to patients, carers,
• Takes a relevant patient history including patient symptoms, concerns,
priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and
psychological findings
• Formulates an appropriate differential diagnosis
• Appropriately selects, manages and interprets investigations
• Demonstrates appropriate continuing management of acute medical
illness in a medical specialty setting
• Refers patients appropriately to other specialties as required
Domain 2: Professional skills:
disease)
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• patient safety
Evidence to MCR
inform MSF
decision CbD
ACAT
Logbook of cases
3. Providing continuity of care to medical inpatients, including management of
• Demonstrates effective consultation skills
• Demonstrates appropriate continuing management of acute medical
illness inpatients admitted to hospital on an acute unselected take or
selected take
• Recognises need to liaise with specialty services and refers where
appropriate
• Appropriately manages comorbidities in medical inpatients (unselected
take, selected acute take or specialty admissions)
• Demonstrates awareness of the quality of patient experience
disease)
• patient safety
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Evidence to MCR
inform MSF
decision ACAT
Mini-CEX
DOPS
4. Managing patients in an outpatient clinic, ambulatory or community setting
(including management of long term conditions)
• Demonstrates effective consultation skills
into account patient preferences
• Appropriately manages comorbidities in outpatient clinic, ambulatory
or community setting
• Demonstrates awareness of the quality of patient experience
disease)
Evidence to MCR
inform ACAT
decision mini-CEX
PS
Letters generated at outpatient clinics
5. Managing medical problems in patients in other specialties and special cases
Descriptors • Demonstrates effective consultation skills (including when in

challenging circumstances)
• Demonstrates management of medical problems in inpatients under
the care of other specialties
• Demonstrates appropriate and timely liaison with other medical
specialty services when required
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disease)
Evidence to MCR
inform ACAT
decision CbD
6. Managing a multidisciplinary team including effective discharge planning
Descriptors • Applies management and team working skills appropriately, including

influencing, negotiating, continuously re-assessing priorities and
effectively managing complex, dynamic situations
• Ensures continuity and coordination of patient care through the
appropriate transfer of information demonstrating safe and effective
handover
• Effectively estimates length of stay
• Identifies appropriate discharge plan
• Recognises the importance of prompt and accurate information sharing
with primary care team following hospital discharge
disease)
Evidence to MCR
inform MSF
decision ACAT
Discharge summaries
7. Delivering effective resuscitation and managing the acutely deteriorating patient
Descriptors • Demonstrates prompt assessment of the acutely deteriorating patient,

including those who are shocked or unconscious
• Demonstrates the professional requirements and legal processes
associated with consent for resuscitation
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• Participates effectively in decision making with regard to resuscitation
decisions, including decisions not to attempt CPR, and involves patients
and their families
• Demonstrates competence in carrying out resuscitation
consent; humane interventions; prescribing medicines safely;
using medical devices safely; infection control and communicable
disease)
• patient safety
Evidence to MCR
inform DOPS
decision ACAT
MSF
ALS certificate
Logbook of cases
Reflection
Descriptors • Identifies patients with limited reversibility of their medical condition

and determines palliative and end of life care needs
• Identifies the dying patient and develops an individualised care plan,
including anticipatory prescribing at end of life
• Demonstrates safe and effective use of syringe pumps in the
palliative care population
• Able to manage pain, breathlessness, agitation and distress
• Facilitates referrals to specialist palliative care across all settings
• Demonstrates effective consultation skills in challenging
circumstances
• Demonstrates compassionate professional behaviour and clinical
judgement
Domain 2: Professional skills:
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disease)
Evidence to MCR
inform CbD
decision Mini-CEX
MSF
Regional teaching
Reflection
3.4 Specialty Capabilities in Practice (CiPs)
The specialty CiPs describe the clinical tasks or activities which are essential to the practice
of Neurology. The CiPs have been mapped to the nine GPC domains to reflect the
professional generic capabilities required to undertake the clinical tasks.
Please note, neurology training also includes stroke. This curriculum should be read in
conjunction with the Stroke Sub-specialty Curriculum. However, for convenience the Stroke
sub-specialty CiPs are included here.
Satisfactory sign off will require educational supervisors to make entrustment decisions on
the level of supervision required for each CiP and if this is satisfactory for the stage of
training, the trainee can progress. More detail is provided in the programme of assessment
section of the curriculum.
As with the generic CiPs there is a set of descriptors of the observable skills and behaviours
which would demonstrate that a trainee has met the minimum level expected. The
descriptors are not a comprehensive list and there may be more examples that would
provide equally valid evidence of performance. The following is a list of those descriptors
that may be appropriate.
Methods of assessment
ACAT Acute care assessment ALS Advanced Life Support
tool
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CbD Case-based discussion DOPS Direct observation of procedural skills
Logbook of cases Log of procedures performed
Minutes of an MDT
meeting
GCP Good Clinical Practice
Evidence of application for
ethical and R&D approval
Mini- Mini-clinical evaluation MCR Multiple consultant report
CEX exercise End of placement reports
Educational supervisor’s report
Clinical supervisor’s report
project assessment tool Student feedback
Certificates and diplomas in teaching
Teaching material e.g. slides, e-
modules, and podcasts.
Mini- Mini Imaging Reflective Evidence of literature search and
IPX Interpretation Tool notes critical appraisal of research
Letters generated at outpatient clinics
End of life care assessment
Mental capacity assessment
Safeguarding assessment
Reflections on regional training
days.
Mortality and morbidity notes
Specialty CiPs
Descriptors
Understands the anatomy and pathophysiology of the clinical
manifestations of disorders of cognition and consciousness, including the
relevance of systemic and psychiatric comorbidity.
Able to write a history by consulting all relevant sources, including

relatives, witnesses and other healthcare professionals.
Able to examine patients using appropriate techniques and rating scales.
Able to select, request and interpret relevant investigations to inform

diagnostic thinking and management, including neuropsychological
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assessments, genetic testing, brain imaging, electroencephalography,
sleep studies, brain biopsy and the analysis of cerebrospinal fluid.
Able to work independently and as part of a multidisciplinary team to

implement appropriate treatments and interventions for patients with
impaired cognition or consciousness, in accordance with national
guidance.
Able to anticipate, recognise and manage complications in accordance

with legal principles including the monitoring of change over time and
the effect of interventions, ceilings of care, and medical and psychosocial
complications.
Able to work with and appropriately refer to other relevant

professionals with apposite expertise in medicine, nursing, professions
allied to medicine, law and advocacy, at every stage of a patient’s
journey.

Domain 5: Capabilities in leadership and team working
Evidence to MCR
inform ACAT
decision Mini-IPX
MSF
Mini-CEX
CbD
Reflective notes
Descriptors Understands the anatomy and pathophysiology of headache and pain,
including the relevance of systemic disease and psychiatric comorbidity.
Able to write a history by consulting all relevant sources, including

relatives and witnesses and other healthcare professionals, in order to
recognise common and rare headache and pain syndromes, including
musculoskeletal disorders.
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Able to select, request and interpret investigations including imaging of
the brain and spine, neurophysiological investigations, visual fields and
optical coherence tomography, and use them effectively to identify the
common and rare causes of headache and pain and their response to
intervention.

implement appropriate treatments, monitor and record their effect, and
institute changes when necessary, in accordance with national guidance.
Able to anticipate, recognise and manage complications including the

physical, psychosocial, vocational and domestic consequences of living
with pain and the side effect of medication.

professionals including specialists from other medical and surgical
disciplines and professions allied to medicine.

Evidence to CbD
inform Mini-IPX
decision Mini-CEX
MSF
DOPS
MCR
PS
Reflective notes
Descriptors Understands the underlying anatomy and pathophysiology of seizures
and epilepsy, including the relevance of physical, neurodevelopmental
and psychiatric comorbidity.
Able to write a history by consulting all relevant sources in order to

distinguish epileptic seizures from syncope, dissociative attacks,
cataplexy and parasomnias and to identify and localise different seizure
types.
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Able to examine patients presenting with transient loss of
consciousness, seizures and epilepsy.
Able to select, request and interpret investigations including ECG, EEG

and video EEG, polysomnography, genetic testing, MRI and functional
imaging techniques, and use them effectively to identify the common
and important epilepsy syndromes and their mimics.

manage patients with epilepsy including the use of anti-epileptic drugs
(AEDs) in acute and chronic presentations, switching AEDs and making
personalised AED decisions that take into account co-morbidity,
concomitant medication, and patient choice.

physical and psychosocial consequences of living with epilepsy, drug side-
effects on the patient and foetus, driving restrictions, safety advice and
sudden unexpected death in epilepsy (SUDEP).

professionals during the course of the illness, in particular when
managing epilepsy in women (including pregnancy), people with
intellectual disability, teenagers transitioning from paediatric services,
and those who may benefit from surgery.

Evidence to CbD
inform Mini-IPX
decision Mini-CEX
MSF
MCR
PS
Reflective notes

Descriptors Understands the underlying anatomy and pathophysiology of
inflammatory and infectious diseases of the nervous system, including
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the treatments and their side effects, and the relevance of comorbidity
and a compromised immune system
Able to write a history by consulting all relevant sources to include past

medical history, lifestyle, travel, occupation and sexual activity.
Able to select, request and interpret relevant investigations including

serology, genetic testing, imaging of the brain and spine,
neurophysiology, tissue culture and histology in order to diagnose and
manage infectious and inflammatory disorders of the nervous system.

treat and implement appropriate interventions and monitoring for acute,
persistent, and progressive presentations, in keeping with national
guidance.
Able to anticipate, recognise and manage complications of the disease

process and its treatment, including secondary infectious, inflammatory
and degenerative processes.

professionals during the course of the illness including specialists from
other medical and surgical disciplines and professions allied to medicine.

Evidence to ACAT
inform Mini-IPX
decision CbD
Mini-CEX
SCE
MCR
MSF
Reflective notes
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Descriptors Understands the underlying anatomy and pathophysiology of
movement disorders including the relevance of comorbidity.
Able to write a history by consulting all relevant sources for patients

presenting with Parkinsonism, tremor, chorea, dystonia, tics, myoclonus,
drug-induced and sleep-related movement disorders.
Able to examine patients using appropriate rating scales for patients

presenting with Parkinsonism, tremor, chorea, dystonia, tics, myoclonus
and drug-induced movement disorders.

genetic tests and brain imaging.

manage and treat movement disorders including the motor and non-
motor symptoms and the selection of patients for advanced therapies, in
accordance with national guidance.
Able to anticipate, recognise and manage complications including

motor, cognitive and behavioural complications.

professionals to manage the cognitive and neuropsychiatric
complications of movement disorders and contribute to planning
palliative and advanced care.

Evidence to ACAT
inform Mini-IPX
decision CbD
Mini-CEX
MSF
MCR
Reflective notes
Page 28 of 70
Descriptors Understands the anatomy and pathophysiology of neuromuscular
disorders, including the relevance of comorbidity.
Able to write a history by consulting all relevant sources including the

patient, relatives and witnesses, and other healthcare professionals.
Able to examine patients with neuromuscular disorders using

appropriate techniques, including those with disorders of eye movement,
swallowing, breathing, mobility, and autonomic function.
Able to select, request and interpret relevant investigations for

neuromuscular disorders, including neurophysiology, genetic tests,
metabolic and antibody testing, imaging, and histopathology.

implement appropriate treatment, interventions and standards of care
for acute, persistent, and progressive presentations of neuromuscular
disorders in accordance with national guidance.

common medical, legal, vocational, and psychosocial consequences of
neuromuscular disorders, and the transition from paediatric to adult
services.

professionals during the course of neuromuscular illness, particularly
regarding resuscitation, feeding, ventilation, advanced decisions and
driving, with the involvement of patients and their families or their
advocates.

Evidence to ACAT
inform Mini-IPX
decision CbD
GCP
Mini-CEX
MSF
MCR
Page 29 of 70
PS
Reflective notes
SCE
7. Managing traumatic brain injury and patients requiring neurorehabilitation
Descriptors Understands the anatomy and pathophysiology of traumatic brain
injury and other causes of acquired brain injury and the mechanisms of
recovery during rehabilitation.
Able to write a history by consulting all relevant sources including eye-

witnesses, family and carers as well as information from healthcare
professionals regarding previous treatment, interventions, complications
and previous rehabilitation.
Able to examine patients with complex neurological disability using

appropriate rating scales and techniques, including assessment of
behaviour, cognition, capacity, mobility, spasticity and sphincter
function.

imaging, neurophysiology, urodynamics, diagnostic trials of intrathecal,
intramuscular and oral therapy, and detailed clinical assessments of
cognitive function and conscious level.

provide informed diagnosis, prognosis and treatment, and implement
appropriate intervention, set goals and plan follow-up using agreed
pathways in accordance with national guidance.
Able to anticipate, recognise and manage complications including

medical, domestic, ethical, legal, vocational, behavioural and
psychosocial complications of severe neurological disability.

professionals regarding resuscitation, comorbidities, bladder and bowel
function, feeding, ventilation, pain control, management of the upper
motor neurone syndrome, advanced decisions and palliation.

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Evidence to ACAT
inform Mini-IPX
decision CbD
Mini-CEX
MSF
DOPS
MCR
PS
Reflective notes
8. Managing neuropsychiatric disorders, and functional neurological disorders

Descriptors Understands how to identify and diagnose functional neurological
disorders on positive grounds.
Able to recognise that functional disorders commonly co-exist with, or

can be a precursor to, other neurological conditions and that
psychological and social factors may affect the presentation and
management of common neurological disorders.
Able to communicate a diagnosis of a functional neurological disorder in

a manner that contributes constructively to the management of the
patient.
Able to describe the elements of further management of functional

neurological disorders and their comorbidities and refer appropriately to
psychiatry, psychology, other medical disciplines and other professions
allied to medicine.
Able to identify the main features of common psychiatric disorders and

describe how they interact with neurological disorders as comorbidities
or intrinsic features of the disorder.
Able to identify the spectrum of psychosis presenting in neurological

and psychiatric conditions.
Able to initiate treatment of common psychiatric disorders and acute

confusion and demonstrate an understanding of how to use the mental
health and mental capacity acts.
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Evidence to CbD
inform Mini-IPX
decision Mini-CEX
MSF
MCR
PS
Reflective notes
Sub-specialty Stroke CiPs (reprinted from the Stroke Subspecialty Curriculum)
1. Managing the care of acute stroke patients, including hyperacute care and
cerebral reperfusion strategies.
Descriptors • Demonstrates knowledge of anatomy, physiology, blood supply and
pathophysiology as relevant to TIA, stroke (including its subtypes) and
common stroke mimics
• Able to conduct an up-to-date hyper-acute stroke clinical assessment
efficiently (including face to face and virtually [e.g. telemedicine])
with appropriate use of imaging to safely deliver treatment including
cerebral reperfusion strategies where indicated
• Able to demonstrate a recognition and management of complications
relating to cerebral reperfusion strategies
• Able to perform a comprehensive, specialist assessment, investigate
and treat patients with stroke or mimic syndromes relevant to the
patient’s age, comorbidities and clinical presentation
• Able to manage comorbidities and risk factors relevant to stroke
appropriately.
• Able to apply principles of early multiprofessional assessment to
understand the physical, psychological and social impact of stroke on
patients and work collaboratively with the stroke unit
multidisciplinary team to guide management strategies including
positioning, hydration, nutrition, continence, risk factor modification
and participation in rehabilitation
• Able to use up-to-date knowledge of evidence, guidelines,
appropriate monitoring and measurement scales (including NIHSS
and mRS) to guide management and anticipate early complications
e.g. malignant MCA syndrome
• Able to recognise and manage the deteriorating stroke patient
including the introduction of palliative care (e.g. communicating
prognostic uncertainty)

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Evidence to ACAT
inform CbD
decision Mini-CEX
Mini-IPX
MSF
QIPAT
DOPS-Cerebral Reperfusions
MCR
PS
Educational Supervisor report
2. Managing the primary and secondary prevention of stroke and Transient
Ischaemic Attack
Descriptors • Demonstrates knowledge of the different pathophysiological
mechanisms, disease processes and causes that underlie the clinical
syndrome of stroke (and its subtypes)
• Able to conduct an urgent clinical evaluation and prioritise safely:
initiating appropriate investigations in a timely manner, interpreting
the results and communicating the management plan effectively
(including face to face and virtually [e.g. telemedicine])
• Able to provide an accurate diagnosis and appropriate
comprehensive management of patients with suspected TIA or stroke
including identification of vascular risk factors and lifestyle
modification
• Able to identify conditions that mimic TIA and stroke and manage
these effectively or make an appropriate referral
• Able to manage comorbidities and risk factors relevant to TIA and
stroke in an outpatient clinic (including tolerating uncertainty where
investigation or intervention may not have high utility or benefit).
• Awareness of up-to-date primary and secondary prevention
treatment strategies for TIA and stroke (including knowledge and
application of national guidance)
• Able to prioritise referrals received through different mechanisms
(e.g. electronic, telephone, in person) and by all healthcare
professionals
• Able to provide appropriate driving, vocational and social advice for
patients with TIA or stroke working in partnership where necessary
with the stroke multidisciplinary team

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Evidence to ACAT
inform CbD
decision Mini-CEX
Mini-IPX
MSF
QIPAT
MCR
PS
3. Managing early and late stroke rehabilitation in hospital and community settings
Descriptors • Understands the anatomy and pathophysiology of stroke with regard
to patterns of recovery relevant to stroke subtypes and other factors
to guide planning and expectations for an individual’s recovery
• Demonstrates an understanding of the diverse factors that can
influence outcome including problems often associated with non-
dominant hemisphere stroke (e.g. higher mental function),
neuropsychiatric consequences, post stroke pain and spasticity
• Appropriately manages common post stroke complications (seizures,
thromboembolism, dysphagia, dehydration, shoulder girdle
dysfunction, spasticity) and takes into account how these may affect
participation in rehabilitation
• Ensures rehabilitation is individualised, patient focused and
recognises how the consequences of stroke disability can impact on
participation in rehabilitation
• Co-ordinates the multidisciplinary team to optimise post stroke
recovery, participation in goal setting, measurement of rehabilitation
outcome, and participation in national audit
• Demonstrates good communication and understanding with patients
and families and identifies carer’s long-term needs and participation
in goal planning
• Demonstrates an understanding of medico-legal issues relating to
clinically assisted nutrition and hydration in patients both with and
without capacity
• Contributes to and leads effective discharge planning to support
transition to the community and facilitate life after stroke, including
engaging with social services that may help optimise on-going
recovery and/or provide support including impact on function,
vocation and driving.
• Understands the impact of cultural and socioeconomic patient
backgrounds on stroke prognosis and rehabilitation outcomes.
• Able to recognise and manage the deteriorating stroke patient
including the introduction of palliative care (e.g. communicating
prognostic uncertainty)
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Evidence to ACAT
inform CbD
decision GCP
Mini-CEX
MSF
QIPAT
MCR
PS
3.5 Presentations and Conditions
The table below details the key presentations and conditions of Neurology. Each of these
should be regarded as a clinical context in which trainees should be able to demonstrate
CiPs and GPCs. In this spiral curriculum, trainees will expand and develop the knowledge,
skills and attitudes around managing patients with these conditions and presentations. The
patient should always be at the centre of knowledge, learning and care.
Trainees must demonstrate core clinical skills, including information gathering through
history and physical examination and information sharing with patients, families and
colleagues.
Treatment care and strategy covers how a doctor selects drug treatments or interventions
for a patient. It includes discussions and decisions as to whether care is focused mainly on
curative intent or whether the main focus is on symptomatic relief. It also covers broader
aspects of care, including involvement of other professionals or services.
Particular presentations, conditions and issues are listed either because they are common or
serious i.e. high morbidity, mortality and/or serious implications for treatment or public
health.
For each presentation and condition trainees will need to be familiar with such aspects as
aetiology, epidemiology, clinical features, investigation, management and prognosis. Our
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approach is to provide general guidance and not exhaustive detail, which would inevitably
become out of date.
The table below lists common presentations and conditions which are of direct relevance to
the Neurology and Stroke CiPs. Where important areas of clinical practice feature in the
Internal Medicine Stage 2 curriculum or are specifically mentioned in the Neurology or
Stroke CiPs, they will not necessarily be duplicated in this table. Important examples include
Clinical Genetics, Clinical Pharmacology and Therapeutics, Psychiatry and Palliative Care,
applied informatics and personalised medicine, which are in the table of presentations and
conditions in the Internal Medicine Curriculum and/or the Neurology or Stroke CiPs.
Areas of practice of potential relevance to all of the Neurology CiPs which are not
emphasised in the Internal Medicine Curriculum are included at the start of this table to
highlight their importance to all eight of the Neurology CiPs.
Clinical area Presentations Conditions/Issues
Examples of presentations Examples of conditions are included

are included in this column, in this column, listed in alphabetical
listed in alphabetical order. order. Where possible duplication
Where possible duplication has been avoided. This is for
has been avoided. This is illustrative purposes and is not an
for illustrative purposes exhaustive list.
and is not an exhaustive
list.
Neurological disorders Headache Eclampsia and pre-eclampsia

during pregnancy New or worsening First presentation of a neurological
neurological deficits condition
Seizures Relapse of a neurological condition
Learning Disability Behavioural change Cognitive impairment
Seizures Epilepsy
Disorders of sleep Hypersomnia Narcolepsy
Insomnia Obstructive sleep apnoea
Movement disorders REM and non-REM sleep disorders
during sleep
Neurological Focal, multifocal, or Acute and delayed neurological
complications of generalised neurological complications of chemotherapy and
cancer deficits radiotherapy
Raised intracranial pressure Malignant meningitis
Seizures Paraneoplastic syndromes
Weight loss Primary and secondary tumours of
the brain, spinal cord and peripheral
nerves
Disorders of CSF Cognitive impairment Communicating hydrocephalus
Gait apraxia Idiopathic intracranial hypertension
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Headache Intracranial hypotension

Optic disc swelling Normal pressure hydrocephalus
Non-communicating hydrocephalus
Disorders of lower Dysarthria Glossopharyngeal Neuralgia
cranial nerves Dysphagia Nuclear, fascicular and peripheral
Dysphonia cranial nerve palsies
Orofacial pain and Trigeminal Neuralgia
numbness
Disorders of spine, Bowel and bladder Autonomic dysreflexia
spinal cord and motor dysfunction Compressive, inflammatory,
and sensory roots Immobility infectious and neoplastic conditions
Limb or back pain of the spinal cord and roots
Motor and sensory deficits Neuropathic pain syndromes
Syringomyelia
Disorders of the Bowel, bladder and sexual Amyloidosis
Autonomic Nervous dysfunction Diabetes Mellitus
system Postural hypotension Guillain-Barré syndrome
Extrapyramidal disorders e.g.
Multiple System Atrophy
Paraneoplastic neuropathies
Pure autonomic failure
Clinical Conditions requiring Normal and abnormal
Neurophysiology investigation electroencephalography
Normal and abnormal
electromyography
Normal and abnormal evoked
potentials
Normal and abnormal nerve
conduction studies
Neuroradiology Conditions requiring Normal and abnormal CT head scans
investigation Normal and abnormal MR scans of
the head and spine
Other imaging techniques e.g.
angiography and PET imaging
Neuroendocrinology Headache Diseases of the hypothalamus
Visual failure Diseases of the pituitary
Neuro-otology Deafness Acoustic neuroma
Disequilibrium Benign Paroxysmal Positional
Dizziness Vertigo
Vertigo Cerebrovascular disease
Labyrinthitis
Ménières disease
Vestibular neuritis
Neuro-ophthalmology Balint’s syndrome Cerebrovascular disease
Diplopia Cranial neuropathies
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Headache Demyelination
Internuclear Disorders of higher visual function
ophthalmoplegia Idiopathic Intracranial
Optic disc swelling Hypertension
Optic neuropathy Ischaemic optic neuropathy
Pupil and lid abnormalities Ocular Myasthenia Gravis
Retrochiasmal field defects Oculosympathetic paresis
Optic neuritis
CiP 1: Managing Acalculia Alcohol-related cognitive

disorders of cognition Amnesia impairment
and consciousness Anxiety Alzheimer’s disease and its variants
Apathy Autoimmune encephalopathy
Aphasia Cerebrovascular disease
Apraxia Chronic traumatic encephalopathy
Delirium Extrapyramidal disorders
Delusional Frontotemporal dementia
misidentification Intracranial hypotension
Depression Lewy Body disease
Dyslexia Prion disease
Personality and Toxic and metabolic states
behavioural change Transient Epileptic Amnesia
Visual inattention and Transient Global Amnesia
neglect
CiP 1: Managing Behavioural change Encephalitis

disorders of cognition Brainstem death Hypoxic encephalopathy
and consciousness Coma Narcolepsy
Disorders of vigilance Neurodegenerative disease
Hypersomnia Non-convulsive status epilepticus
Insomnia Prion disease
Locked-in syndrome Raised intracranial pressure
Minimally conscious state Toxic and metabolic states
Prolonged disorders of Traumatic brain injury
consciousness (PDOC)
CiP 2: Managing Acute headache Atypical facial pain

headache and pain Chronic headache Autonomic cephalgias
Episodic headache Cerebrovascular disease
Facial pain Cluster headache
Periorbital pain Giant Cell Arteritis
Glaucoma
Glossopharyngeal neuralgia
Headache of musculoskeletal origin
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Hypnic headache
Low pressure headache
Idiopathic Intracranial hypertension
Malignant meningitis
Medication overuse headache
Migraine
Pituitary tumours
Primary brain tumours
Secondary brain tumours
Temperomandibular joint
dysfunction
Trigeminal Neuralgia
CiP 2: Managing Back pain Cancer-related pain

headache and pain Limb pain Cervical myeloradiculopathy
Neuropathic pain Lumbar disc disease
Peripheral neuropathy
Post-stroke pain syndromes
Secondary pain syndromes
Spinal cord disorders
Thoracic outlet syndrome
CiP 3: Managing Atonic seizures Autoimmune encephalitides
seizures and epilepsy Dissociative seizures Degenerative diseases associated
Drop attacks with epilepsy
Episodic focal neurological Developmental conditions
symptoms associated with epilepsy
Focal seizures Eclampsia
Myoclonus Focal epilepsy
Paroxysmal nocturnal Generalised epilepsy
events Genetic causes of epilepsy
Peri-partum seizures Mitochondrial diseases
Post-ictal psychosis Narcolepsy with or without
Post-operative seizures cataplexy
Pre-ictal psychosis Non-convulsive status epilepticus
Syncope Status epilepticus
Tonic seizures SUDEP
Tonic-clonic seizures Syncope
Transient amnesia Toxic and metabolic states
Transient loss of
consciousness
CiP 4: Managing Abnormal behaviour Acute Disseminated
inflammatory and Abnormal sensation Encephalomyelopathy
infectious disorders Acute confusion Antibody mediated disorders
Ataxia Autoimmune encephalitis
Behçet’s syndrome
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Bladder, bowel and sexual Chronic relapsing inflammatory

dysfunction optic neuropathy (CRION)
Cognitive impairment Collagen vascular disorders
Diplopia Complications of cancer therapy
Disequilibrium Complications of immune
Dysarthria and dysphagia suppression
Encephalopathy Connective tissue disorders
Headache Disorders of eye movement
Hypomania and mania Histiocytosis and related conditions
Immobility IgG4 disease
Intractable vomiting Immune reconstitution conditions
Tonic seizures MOG antibody disease
Vertigo Multiple Sclerosis and related
Visual loss disorders
Weakness Neuromyelitis optica and related
disorders
Optic Neuritis
Paraneoplastic conditions
Primary CNS vasculitis
Sarcoidosis
CiP 4: Managing Bacterial meningitis

inflammatory and Cognitive decline Cerebral/epidural abscess
infectious disorders Delirium Chronic viral infections including HIV
Diplopia Complications of HIV infection
Facial weakness Complications of immune
Fever suppression
Focal weakness Complications of treatments
Headache Fungal infections
Paraparesis Hydrocephalus
Pyrexia of unknown origin Parasitic infection
Seizures Syphilis
Weight loss Tuberculous meningitis
Viral encephalitis
Viral meningitis
CiP 5: Managing Behavioural change Cerebrovascular disease

movement disorders Cerebellar Ataxia Corticobasal syndrome
Chorea Drug-induced movement disorders
Constipation Essential Tremor
Disorders of balance Functional movement disorders
Disorders of gaze Genetic causes of ataxia
Dystonia
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Myoclonus Genetic causes of movement

Parkinsonism disorders
Sexual dysfunction Huntington’s disease
Tics Multiple System Atrophy
Tremor Parkinson’s disease
Progressive Supranuclear Palsy
Tourette’s syndrome
Toxic and metabolic states
CiP 6: Managing Changes in posture Acquired myopathy
neuromuscular Contractures Acquired neuropathy
disorders Dysarthria Autonomic neuropathy
Dysphagia Congenital muscle syndromes
Dysphonia Critical care neuromyopathy
Falls Degenerative myeloradiculopathies
Fasciculations Drug induced neuropathies
Focal weakness Guillain-Barré syndrome
Global weakness Immune mediated neuropathy and
Immobility myopathy
Kyphoscoliosis Infectious neuropathy and
Malignant Hyperthermia myopathy
Myokymia Inherited myopathies
Myotonia Inherited neuropathies
Ophthalmoplegia Lambert-Eaton Myasthenic
Pain syndrome
Ptosis Metabolic myopathy
Rhabdomyolysis Mitochondrial myopathy
Sensory disturbance Mitochondrial neuropathy
Type 2 Respiratory failure Motor Neurone Disease
Myasthenia Gravis
Nerve and muscle injuries
Paraneoplastic neuropathies
Spinal Muscular Atrophy
Vasculitis
CiP 7: Managing Affective and behavioural Chronic Traumatic Encephalopathy
traumatic brain injury change (CTE)
and patients requiring Altered consciousness Diffuse axonal injury
neurorehabilitation Episodic depression Epilepsy
Episodic dyscontrol Hypopituitarism
Frontal lobe paradox Intracerebral haemorrhage
Hearing loss and vertigo Subdural/extradural haemorrhage
Post traumatic amnesia Traumatic cranial nerve palsies
Post-concussion syndrome Traumatic subarachnoid
Post-traumatic amnesia haemorrhage
Post-traumatic cognitive
impairment
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Post-traumatic headache
Post-traumatic sleep
disorder
Raised/reduced intracranial
pressure
CiP 7: Managing Bowel, bladder and sexual Acquired brain injury

traumatic brain injury dysfunction Cerebral palsy
and patients requiring Cognitive impairment Multiple Sclerosis
neurorehabilitation Conduct disorder Neuromuscular weakness
Contractures Polyneuropathy
Deafness Post infectious disorders
Disequilibirum Rehabilitation following
Gait disorders neurosurgery
Pain Spinal cord injury
Proprioceptive disorders
Spasticity
Visuospatial disorders
CiP 8: Managing Anxiety Autoimmune encephalitis

neuropsychiatric Behavioural disorders Cerebrovascular disease
disorders, and Depression Dementia
functional Panic Attack Dissociative seizures
neurological disorders Psychosis Movement disorders
Suicidal ideation Schizophrenia
CiP 8: Managing Chronic pain Functional cognitive disorder

neuropsychiatric Cognitive impairment Functional movement disorder
disorders, and Dizziness Functional sensory loss
functional Dysarthria Functional visual loss
neurological disorders Dysphagia Functional weakness
Dysphonia Persistent posture-perceptual
Fatigue dizziness (PPPD)
Unexplained blackouts
Visual impairments
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System/Specialty and Presentations Conditions/Issues
specialist clinical area
Acute Stroke or Mimic Weakness unilateral or Acute Cerebral Infarction
bilateral Acute Intracerebral Haemorrhage
Inattention TIA
Dysarthria Cerebral Amyloidosis
Dysphasia Transient Amnesias
Dysphagia Acute and remote seizure(s)
Vertigo Cerebral Venous Thrombosis
Unsteadiness Migraine
Monocular Visual loss Syncope
Visual Field impairment Subdural Haemorrhage
Altered sensation Subarachnoid Haemorrhage
Sudden unconsciousness Amaurosis Fugax
Space Occupying Lesion
Bell’s Palsy
Functional Neurological Disorder
Facial mononeuropathy
Peripheral neuropathy
Vestibular disorders
Systemic / Metabolic disorders
Primary or Secondary Weakness unilateral or Acute Cerebral Infarction

Prevention of Stroke, bilateral Acute Intracerebral Haemorrhage
Transient Ischaemic Inattention TIA
Attack or Mimic Dysarthria Central retinal artery occlusion
Dysphasia Cerebral Amyloidosis
Dysphagia Transient Amnesias
Vertigo Acute and remote seizure(s)
Unsteadiness Migraine
Visual Loss Syncope
Altered sensation Subdural Haemorrhage
Cognitive decline Space Occupying Lesion
Bell’s Palsy
Atrial Fibrillation
Cervical Arterial disease
Cardiac disease
Vascular cognitive impairment
Medical Care and Incontinence of urine Cerebral infarction

Rehabilitation Incontinence of faeces Intracerebral haemorrhage
following stroke Oral feeding failure Pneumonia
Immobility, including Incontinence
problems with standing Post Stroke Pain
and transfers Post Stroke Depression
Communication problems Post Stroke Epilepsy
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System/Specialty and Presentations Conditions/Issues
specialist clinical area
Disorders of conduct and Vascular cognitive impairment
behaviour Venous thromboembolic disease
Spasticity Upper motor neurone syndrome
Pain
Seizures
Disorders of mood
Musculoskeletal
complications of
neurological disease
Visual Loss
Disorders of perception
and visuospatial neglect
Abnormal Sensation
Disorders of cognition
Fatigue
Complications of
immobility
3.6 Practical procedures
There are a number of procedural skills in which a trainee must become proficient.
Trainees must be able to outline the indications for these procedures and recognise the
importance of valid consent, aseptic technique, safe use of analgesia and local anaesthetics,
minimisation of patient discomfort, and requesting help when appropriate. For all practical
procedures the trainee must be able to recognise complications and respond appropriately
if they arise, including calling for help from colleagues in other specialties when necessary.
Trainees should receive training in procedural skills in a clinical skills lab if required.
Assessment of procedural skills will be made using the direct observation of procedural skills
(DOPS) tool. The table below sets out the minimum competency level expected for each of
the practical procedures.
When a trainee has been signed off as being able to perform a procedure independently,
they are not required to have any further assessment (DOPS) of that procedure, unless they
or their educational supervisor think that this is required (in line with standard professional
conduct).
Procedure ST3 ST4 ST5 ST6 ST7

Minimum level required
Lumbar Puncture Able to Competent Maintain Maintain Maintain
(Diagnostic and perform the to perform
therapeutic) procedure the
with limited procedure
supervision unsupervised
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Procedure ST3 ST4 ST5 ST6 ST7
Botulinum toxin Able to Maintain Maintain Maintain Maintain
injection perform the
(hemifacial spasm, procedure
cervical dystonia, under
spasticity, migraine) direct
supervision
Greater Occipital nerve Able to Maintain Maintain Maintain Maintain
injections perform the
procedure
under
direct
supervision
4 Learning and Teaching
4.1 The training programme
The organisation and delivery of postgraduate training is the responsibility of the Health
Education England (HEE), NHS Education for Scotland (NES), Health Education and
Improvement Wales (HEIW) and the Northern Ireland Medical and Dental Training Agency
(NIMDTA) – referred to from this point as ‘deaneries’. A training programme director (TPD)
will be responsible for coordinating the specialty training programme. In England, the local
organisation and delivery of training is overseen by a school of medicine.
Progression through the programme will be determined by the Annual Review of

Competency Progression (ARCP) process and the training requirements for each indicative
year of training are summarised in the ARCP decision aid (available on the JRCPTB website).
The sequence of training should ensure appropriate progression in experience and

responsibility. The training to be provided at each training site is defined to ensure that,
during the programme, the curriculum requirements are met and also that unnecessary
duplication and educationally unrewarding experiences are avoided.
Trainees will have an appropriate Clinical Supervisor (CS) and a named Educational
Supervisor (ES). The clinical supervisor and educational supervisor may be the same person.
It will be best practice for trainees to have an educational supervisor who practises internal
medicine for periods of IM stage 2 training. Educational supervisors of IM trainees who do
not themselves practise IM must take particular care to ensure that they obtain and
consider detailed feedback from clinical supervisors who are knowledgeable about the
trainees’ IM performance and include this in their educational reports.
Each training programme will include placements to cover the Neurology CiPs. All trainees
will also complete the three stroke CiPs, therefore this curriculum should be read in
conjunction with the most up-to-date stroke subspecialty curriculum
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Recommended training
Trainees will be encouraged to engage with a range of healthcare professionals who
diagnose and treat patients with neurological conditions including amongst many others
Neuroradiologists, Neurosurgeons, Neurophysiologists, Neuropsychiatrists, Urologists,
Clinical Psychologists, Physiotherapists and Speech Therapists.
4.2 Teaching and learning methods

The curriculum will be delivered through a variety of learning experiences and will achieve
the capabilities described in the syllabus through a variety of learning methods. There will
be a balance of different modes of learning from formal teaching programmes to
experiential learning ‘on the job’. The proportion of time allocated to different learning
methods may vary depending on the nature of the attachment within a rotation.
This section identifies the types of situations in which a trainee will learn.
The content of work-based experiential learning is decided by the local faculty for education
but includes active participation in:
Medical clinics including specialty clinics

The educational objectives of attending clinics are:
• To understand the management of chronic diseases and the prevention of avoidable
disability
• Be able to assess a patient in a defined time-frame
• To interpret and act on the referral letter to clinic
• To propose an investigation and management plan in a setting different from the
acute medical situation
• To review and amend existing investigation plans
• To write an informative letter back to the referrer
• To communicate with the patient and where necessary relatives and other health
care professionals.
These objectives can be achieved in a variety of settings including hospitals, day care
facilities and the community. The clinic might be primarily run by a specialist nurse (or other
qualified health care professionals) rather than a consultant physician. After initial
induction, trainees will review patients in clinic settings, under direct supervision. The
degree of responsibility taken by the trainee will increase as competency increases. Trainees
should see a range of new and follow-up patients and present their findings to their clinical
supervisor. Clinic letters written by the trainee should also be reviewed and feedback given.
The number of patients that a trainee should see in each clinic is not defined, neither is the
time that should be spent in clinic, but as a guide this should be a minimum of two hours.
Clinic experience should be used as an opportunity to undertake supervised learning events

and reflection.
Reviewing patients with consultants
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It is important that trainees have an opportunity to present at least a proportion of the
patients whom they have admitted to their consultant for senior review in order to obtain
immediate feedback into their performance (that may be supplemented by an appropriate
WBA such as an ACAT, mini-CEX or CBD). This may be accomplished when working on a take
shift along with a consultant, or on a post-take ward round with a consultant.
Personal ward rounds and provision of ongoing clinical care on specialist medical ward
attachments
Every patient seen, on the ward or in outpatients, provides a learning opportunity, which
will be enhanced by following the patient through the course of their illness. The experience
of the evolution of patients’ problems over time is a critical part both of the diagnostic
process as well as management. Patients seen should provide the basis for critical reading
and reflection on clinical problems.
Ward rounds by more senior doctors

Every time a trainee observes another doctor seeing a patient or their relatives there is an
opportunity for learning. Ward rounds (including post-take) should be led by a more senior
doctor and include feedback on clinical and decision-making skills.
Multidisciplinary team meetings

There are many situations where clinical problems are discussed with clinicians in other
disciplines. These provide excellent opportunities for observation of clinical reasoning.
Trainees have supervised responsibility for the care of inpatients. This includes day-to-day
review of clinical conditions, note keeping, and the initial management of the acutely ill
patient with referral to and liaison with clinical colleagues as necessary. The degree of
responsibility taken by the trainee will increase as competency increases. There should be
appropriate levels of clinical supervision throughout training, with increasing clinical
independence and responsibility.
Telephone clinics and video consultations.

The changes in the delivery of healthcare associated with the COVID epidemic has led to the
increased use of remote consultations, particularly for follow-up consultations and for the
triage of new referrals. Training in the appropriate use of these techniques will be required.
Palliative and end of life care

The palliative care needs of patients with diseases of the nervous system are importantly
different to those of patients with advanced malignancy. The ability to communicate may
be compromised at an early stage, and pain may be only a minor symptom compared to
breathlessness, confusion, agitation, seizures and oral feeding failure.
Trainees undertaking a palliative medicine attachment (this will not be obligatory for
Neurology trainees but could with planning be included in a placement on an appropriate
training programme) will see palliative care patients with a range of life-limiting illnesses,
including cancer, frailty, multimorbidity, dementia and organ failure. They will gain expertise
in:
• Managing difficult physical symptoms;
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• Managing psychological, spiritual and existential distress for patients and those
close to them.
• Addressing complex social issues for patients at the end of life (including facilitating
preferences for place of care and death).
• Managing challenging symptoms in the dying patient.
• Identifying those in need of proactive or enhanced bereavement support.
• Managing palliative care patients out of hours, including in non-acute settings
(hospice and community).
Trainees will also have the opportunity to:

• Enhance skills in recognising the patient with limited reversibility of their medical
condition and the dying patient.
• Improve understanding of the range of interventions that can be delivered in acute
and non-acute settings (e.g. community, hospice or care home);
• Increase confidence in developing and communicating appropriate advance care
plans, including DNACPR and treatment escalation decisions.
• Increase confidence in providing a senior opinion where there is conflict regarding a
patient’s goals of care.
• Increase confidence in working in an advisory/liaison role, e.g. in hospital or
community, providing advice to other multiprofessional teams.
Formal postgraduate teaching

The content of these sessions are determined by the local faculty of medical education and
will be based on the curriculum. There are many opportunities throughout the year for
formal teaching in the local postgraduate teaching sessions and at regional, national and
international meetings. Many of these are organised by the Royal Colleges of Physicians.
Suggested activities include:

• a programme of formal bleep-free regular teaching sessions to cohorts of trainees (e.g. a
weekly training hour for IM teaching within a training site)
• case presentations
• research, audit and quality improvement projects
• lectures and small group teaching
• Grand Rounds
• clinical skills demonstrations and teaching
• critical appraisal and evidence based medicine and journal clubs
• joint specialty meetings
• attendance at training programmes organised on a deanery or regional basis, which are
designed to cover aspects of the training programme outlined in this curriculum.
Learning with peers - There are many opportunities for trainees to learn with their peers.
Local postgraduate teaching opportunities allow trainees of varied levels of experience to
come together for small group sessions.
Independent self-directed learning
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Trainees will use this time in a variety of ways depending upon their stage of learning.
Suggested activities include:
• reading, including web-based material such as e-Learning for Healthcare (e-LfH)
• maintenance of personal portfolio (self-assessment, reflective learning, personal
development plan)
• audit, quality improvement and research projects
• reading journals
• achieving personal learning goals beyond the essential, core curriculum
Formal study courses

Time to be made available for formal courses is encouraged, subject to local conditions of
service. Examples include management and leadership courses and communication courses,
which are particularly relevant to patient safety and experience.
4.3 Academic training

The four nations have different arrangements for academic training and doctors in training
should consult the local deanery for further guidance.
Trainees may train in academic medicine as an academic clinical fellow (ACF), academic
clinical lecturer (ACL) or equivalent.
Some trainees may opt to do research leading to a higher degree, without being appointed
to a formal academic programme. This new curriculum supports doctors who wish to apply
for the opportunity to take time out of programme to do research (OOPR) but, as now, this
will require discussion between the trainee and the Training Programme Director, and all
applications will need the support of the Postgraduate Dean and the SAC to ensure that the
proposed period –usually a maximum of three years - and the scope of the research is
appropriate, and that time out of programme is justified.
4.4 Taking time out of programme

There are a number of circumstances when a trainee may seek to spend some time out of
specialty training, such as undertaking a period of research or taking up a fellowship post.
All such requests must be agreed by the postgraduate dean in advance and trainees are
advised to discuss their proposals as early as possible. Full guidance on taking time out of
programme can be found in the Gold Guide.
4.5 Acting up as a consultant

A trainee coming towards the end of their training may spend up to three months “acting-
up” as a consultant, provided that a consultant supervisor is identified for the post and
satisfactory progress is made. As long as the trainee remains within an approved training
programme, the GMC does not need to approve this period of “acting up” and their original
CCT date will not be affected. More information on acting up as a consultant can be found in
the Gold Guide.
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5 Programme of assessment
5.1 Purpose of assessment
The purpose of the programme of assessment is to:
• assess trainees’ actual performance in the workplace
• enhance learning by providing formative assessment, enabling trainees to receive
immediate feedback, understand their own performance and identify areas for
development
• drive learning and enhance the training process by making it clear what is required of
trainees and motivating them to ensure they receive suitable training and experience
• demonstrate trainees have acquired the GPCs and meet the requirements of GMP
• ensure that trainees possess the essential underlying knowledge required for their
specialty
• provide robust, summative evidence that trainees are meeting the curriculum standards
during the training programme
• inform the ARCP, identifying any requirements for targeted or additional training where
necessary and facilitating decisions regarding progression through the training
programme
• identify trainees who should be advised to consider changes of career direction.
5.2 Programme of Assessment

Our programme of assessment refers to the integrated framework of exams, assessments in
the workplace and judgements made about a learner during their approved programme of
training. The purpose of the programme of assessment is to robustly evidence, ensure and
clearly communicate the expected levels of performance at critical progression points in,
and to demonstrate satisfactory completion of training as required by the curriculum.
The programme of assessment is comprised of several different individual types of

assessment. A range of assessments is needed to generate the necessary evidence required
for global judgements to be made about satisfactory performance, progression in, and
completion of, training. All assessments, including those conducted in the workplace, are
linked to the relevant curricular learning outcomes (e.g. through the blueprinting of
assessment system to the stated curricular outcomes).
The programme of assessment emphasises the importance and centrality of professional

judgement in making sure learners have met the learning outcomes and expected levels of
performance set out in the approved curricula. Assessors will make accountable,
professional judgements. The programme of assessment includes how professional
judgements are used and collated to support decisions on progression and satisfactory
completion of training.
The assessments will be supported by structured feedback for trainees. Assessment tools
will be both formative and summative and have been selected on the basis of their fitness
for purpose.
Assessment will take place throughout the training programme to allow trainees continually
to gather evidence of learning and to provide formative feedback. Those assessment tools
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which are not identified individually as summative will contribute to summative judgements
about a trainee’s progress as part of the programme of assessment. The number and range
of these will ensure a reliable assessment of the training relevant to their stage of training
and achieve coverage of the curriculum.
Reflection and feedback should be an integral component to all SLEs and WBPAs. In order
for trainees to maximise benefit, reflection and feedback should take place as soon as
possible after an event. Every clinical encounter can provide a unique opportunity for
reflection and feedback and this process should occur frequently. Feedback should be of
high quality and should include an action plan for future development for the trainee. Both
trainees and trainers should recognise and respect cultural differences when giving and
receiving feedback.
5.3 Assessment of CiPs
Assessment of CiPs involves looking across a range of different skills and behaviours to make
global decisions about a learner’s suitability to take on particular responsibilities or tasks.
Clinical supervisors and others contributing to assessment will provide formative feedback
to the trainee on their performance throughout the training year. This feedback will include
a global rating in order to indicate to the trainee and their educational supervisor how they
are progressing at that stage of training. To support this, workplace based assessments and
multiple consultant reports will include global assessment anchor statements.
Global assessment anchor statements
➢ Below expectations for this year of training; may not meet the requirements for critical
progression point
➢ Meeting expectations for this year of training; expected to progress to next stage of training
➢ Above expectations for this year of training; expected to progress to next stage of training
Towards the end of the training year, trainees will make a self-assessment of their
progression for each CiP and record this in the eportfolio with signposting to the evidence to
support their rating.
The educational supervisor (ES) will review the evidence in the eportfolio including
workplace based assessments, feedback received from clinical supervisors (via the Multiple
Consultant Report) and the trainee’s self-assessment and record their judgement on the
trainee’s performance in the ES report, with commentary.
For generic CiPs, the ES will indicate whether the trainee is meeting expectations or not
using the global anchor statements above. Trainees will need to be meeting expectations for
the stage of training as a minimum to be judged satisfactory to progress to the next training
year.
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For clinical and specialty CiPs, the ES will make an entrustment decision for each CiP and
record the indicative level of supervision required with detailed comments to justify their
entrustment decision. The ES will also indicate the most appropriate global anchor
statement (see above) for overall performance.
Level descriptors for clinical and specialty CiPs
Level Descriptor
Level 1 Entrusted to observe only – no provision of clinical care
Level 2 Entrusted to act with direct supervision:

The trainee may provide clinical care, but the supervising physician is physically
within the hospital or other site of patient care and is immediately available if
required to provide direct bedside supervision
Level 3 Entrusted to act with indirect supervision:

The trainee may provide clinical care when the supervising physician is not physically
present within the hospital or other site of patient care, but is available by means of
telephone and/or electronic media to provide advice, and can attend at the bedside if
required to provide direct supervision
Level 4 Entrusted to act unsupervised
The ARCP will be informed by the ES report and the evidence presented in the eportfolio.
The ARCP panel will make the final summative judgement on whether the trainee has
achieved the generic outcomes and the appropriate level of supervision for each CiP. The
ARCP panel will determine whether the trainee can progress to the next year/level of
training in accordance with the Gold Guide. ARCPs will be held for each training year. The
final ARCP will ensure trainees have achieved level 4 in all CiPs for the critical progression
point at completion of training.
5.4 Critical progression points
There will be a key progression point on entry and on completion of specialty training.
Trainees will be required to be entrusted at level 4 in all CiPs in order to achieve an ARCP
outcome 6 and be recommended for a CCT.
The educational supervisor report will make a recommendation to the ARCP panel as to
whether the trainee has met the defined levels for the CiPs and acquired the procedural
competence required for each year of training. The ARCP panel will make the final decision
on whether the trainee can be signed off and progress to the next year/level of training [see
section 5.6].
The outline grids below set out the expected level of supervision and entrustment for the
IM clinical CiPs and the specialty CiPs and include the critical progression points across the
whole training programme.
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Table 1: Outline grid of levels expected for Internal Medicine clinical capabilities in practice (CiPs)
Level descriptors
Level 1: Entrusted to observe only – no clinical care
Level 2: Entrusted to act with direct supervision
Level 3: Entrusted to act with indirect supervision
Level 4: Entrusted to act unsupervised
IM Clinical CiP ST4 ST5 ST6 ST7

4
2. Managing the acute care of patients within a medical specialty
CRITICAL PROGRESSION POINT

3 4
service
3. Providing continuity of care to medical inpatients
4
4. Managing outpatients with long term conditions 4

5. Managing medical problems in patients in other specialties and
4
special cases
6. Managing an MDT including discharge planning
4
7. Delivering effective resuscitation and managing the deteriorating

4
patient
4
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Table 2: Outline grid of levels expected for Neurology specialty capabilities in practice (CiPs)
Levels to be achieved by the end of each training year for specialty CiPs
Level descriptors
Level 1: Entrusted to observe only – no clinical care
Level 2: Entrusted to act with direct supervision
Level 3: Entrusted to act with indirect supervision
Level 4: Entrusted to act unsupervised
Neurology CiPs ST4 ST5 ST6 ST7 ST8

2 2 3 3 4

2 2 3 3 4
CRITICAL PROGRESSION POINT

2 2 3 3 4

2 2 3 3 4

2 2 3 3 4

2 2 3 3 4
7. Managing traumatic brain injury and patients

requiring neurorehabilitation 2 2 3 3 4
8. Managing neuropsychiatric disorders, including

functional disorders 2 2 3 3 4
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The Stroke sub-specialty CiPs are included here for information and clarity
Stroke sub-specialty CiPs ST4 ST5 ST6 ST7 ST8
CRITICAL PROGRESSION
1. Managing the care of acute stroke patients, including
2 2 2 2 4
hyperacute care and cerebral reperfusion strategies
POINT
2. Managing the primary and secondary prevention of
2 2 2 2 4
stroke and Transient Ischaemic Attack
3. Managing early and late stroke rehabilitation in
2 2 2 2 4
hospital and community settings
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5.5 Evidence of progress
The following methods of assessment will provide evidence of progress in the integrated
programme of assessment. The requirements for each training year/level are stipulated in
the ARCP decision aid (www.jrcptb.org.uk).
Summative assessment
Examinations and certificates

• Advanced Life Support Certificate (ALS)
• Specialty Certificate Examination (SCE)
The Specialty Certificate Examination has been developed by the Federation of Royal
Colleges of Physicians in conjunction with Association of British Neurologists. The
examination tests the extra knowledge base that trainees have acquired since taking the
MRCP(UK) diploma. The knowledge base itself must be associated with adequate use of
such knowledge and passing this examination must be combined with satisfactory progress
in workplace based assessments for the trainee to successfully reach the end of training and
be awarded the CCT in Neurology. Information is available on the MRCPUK website
Workplace-based assessment (WPBA)

• Direct Observation of Procedural Skills (DOPS) – summative
Formative assessment
Supervised Learning Events (SLEs)

• Acute Care Assessment Tool (ACAT)
• Case-Based Discussions (CbD)
• mini-Clinical Evaluation Exercise (mini-CEX)
• mini-Imaging Interpretation Exercise (mini-IPX)
WPBA
• Direct Observation of Procedural Skills (DOPS) – formative
• Multi Source Feedback (MSF)
• Patient Survey (PS)
• Quality Improvement Project Assessment Tool (QIPAT)
• Teaching Observation (TO)
Supervisor reports
• Multiple Consultant Report (MCR)
• Educational Supervisor Report (ESR)
• Clinical Supervisor Report (CSR)
These methods are described briefly below. More information and guidance for trainees
and assessors are available in the eportfolio and on the JRCPTB website
(www.jrcptb.org.uk).
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Assessment should be recorded in the trainee’s eportfolio. These methods include feedback
opportunities as an integral part of the programme of assessment.
Acute Care Assessment Tool (ACAT)

The ACAT is designed to assess and facilitate feedback on a doctor’s performance during
their practice on the acute medical take. It is primarily for assessment of their ability to
prioritise, to work efficiently, to work with and lead a team, and to interact effectively with
nursing and other colleagues. It can also be used for assessment and feedback in relation to
care of individual patients. Any doctor who has been responsible for the supervision of the
acute medical take can be the assessor for an ACAT.
Case-based Discussion (CbD)

The CbD assesses the performance of a trainee in their management of a patient to provide
an indication of competence in areas such as clinical reasoning, decision-making and
application of medical knowledge in relation to patient care. It also serves as a method to
document conversations about, and presentations of, cases by trainees. The CbD should
focus on a written record (such as written case notes, out-patient letter, and discharge
summary). A typical encounter might be when presenting newly referred patients in the
out-patient department.
Direct Observation of Procedural Skills (DOPS)

A DOPS is an assessment tool designed to evaluate the performance of a trainee in
undertaking a practical procedure, against a structured checklist. The trainee receives
immediate feedback to identify strengths and areas for development. DOPS can be
undertaken as many times as the trainee and their supervisor feel is necessary (formative).
A trainee can be regarded as competent to perform a procedure independently after they
are signed off as such by an appropriate assessor (summative).
mini-Clinical Evaluation Exercise (mini-CEX)

This tool evaluates a clinical encounter with a patient to provide an indication of
competence in skills essential for good clinical care such as history taking, examination and
clinical reasoning. The trainee receives immediate feedback to aid learning. The mini-CEX
can be used at any time and in any setting when there is a trainee and patient interaction
and an assessor is available.
mini-Imaging Interpretation Exercise (mini-IEX)

This tool evaluates a trainee’s skills in interpreting an imaging study and is designed to
provide rapid and prompt feedback to a trainee in a particular area of diagnostic imaging.
Multi Source Feedback (MSF)

This tool is a method of assessing generic skills such as communication, leadership, team
working, reliability etc, across the domains of Good Medical Practice. This provides
systematic collection and feedback of performance data on a trainee, derived from a
number of colleagues. ‘Raters’ are individuals with whom the trainee works, and includes
doctors, administrative staff, and other allied professionals. Raters should be agreed with
the educational supervisor at the start of the training year. The trainee will not see the
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individual responses by raters. Feedback is given to the trainee by the Educational
Supervisor.
Patient Survey (PS)

A trainee’s interaction with patients should be continually observed and assessed. The
Patient Survey provides a tool to assess a trainee during a consultation period. The Patient
Survey assesses the trainee’s performance in areas such as interpersonal skills,
communication skills and professionalism.
Quality Improvement Project Assessment Tool (QIPAT)

The QIPAT is designed to assess a trainee's competence in completing a quality
improvement project. The QIPAT can be based on review of quality improvement project
documentation or on a presentation of the quality improvement project at a meeting. If
possible the trainee should be assessed on the same quality improvement project by more
than one assessor.
Teaching Observation (TO)

The TO form is designed to provide structured, formative feedback to trainees on their
competence at teaching. The TO can be based on any instance of formalised teaching by the
trainee which has been observed by the assessor. The process should be trainee-led
(identifying appropriate teaching sessions and assessors).
Reflective notes
Reflections on courses attended, audit meetings, morbidity and mortality meetings,
encounters with relatives, assessments of capacity and personal interactions with
colleagues are valuable sources of learning.
Supervisors’ reports
Multiple Consultant Report (MCR)

The MCR captures the views of consultant supervisors based on observation on a trainee's
performance in practice. The MCR feedback and comments received give valuable insight
into how well the trainee is performing, highlighting areas of excellence and areas of
support required. MCR feedback will be available to the trainee and contribute to the
educational supervisor’s report.
Educational Supervisors Report (ESR)

The ES will periodically (at least annually) record a longitudinal, global report of a trainee’s
progress based on a range of assessment, potentially including observations in practice or
reflection on behaviour by those who have appropriate expertise and experience. The ESR
will include the ES’s summative judgement of the trainee’s performance and the
entrustment decisions given for the learning outcomes (CiPs). The ESR can incorporate
commentary or reports from longitudinal observations, such as from supervisors or
formative assessments demonstrating progress over time.
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5.6 Decisions on progress (ARCP)
The decisions made at critical progression points and upon completion of training should be
clear and defensible. They must be fair and robust and make use of evidence from a range
of assessments, potentially including exams and observations in practice or reflection on
behaviour by those who have appropriate expertise or experience. They can also
incorporate commentary or reports from longitudinal observations, such as from
supervisors or formative assessments demonstrating progress over time.
Periodic (at least annual) review should be used to collate and systematically review
evidence about a doctor’s performance and progress in a holistic way and make decisions
about their progression in training. The annual review of progression (ARCP) process
supports the collation and integration of evidence to make decisions about the achievement
of expected outcomes.
Assessment of CiPs involves looking across a range of different skills and behaviours to make
global decisions about a learner’s suitability to take on particular responsibilities or tasks, as
do decisions about the satisfactory completion of presentations/conditions and procedural
skills set out in this curriculum. The outline grid in section 5.4 sets out the level of
supervision expected for each of the clinical and specialty CiPs. The table of practical
procedures sets out the minimum level of performance expected at the end of each year or
training. The requirements for each year of training are set out in the ARCP decision aid
(www.jrcptb.org.uk).
The ARCP process is described in the Gold Guide. Deaneries are responsible for organising
and conducting ARCPs. The evidence to be reviewed by ARCP panels should be collected in
the trainee’s eportfolio.
As a precursor to ARCPs, JRCPTB strongly recommend that trainees have an informal

eportfolio review either with their educational supervisor or arranged by the local school of
medicine. These provide opportunities for early detection of trainees who are failing to
gather the required evidence for ARCP.
There should be review of the trainee’s progress to identify any outstanding targets that the
trainee will need to complete to meet all the learning outcomes for completion training
approximately 12-18 months before CCT. This should include an external assessor from
outside the training programme.
In order to guide trainees, supervisors and the ARCP panel, JRCPTB has produced an ARCP
decision aid which sets out the requirements for a satisfactory ARCP outcome at the end of
each training year and critical progression point. The ARCP decision aid is available on the
JRCPTB website www.jrcptb.org.uk.
Poor performance should be managed in line with the Gold Guide.
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5.7 Assessment blueprint
The tables below show the possible methods of assessment for each CiP. It is not expected
that every method will be used for each competency and additional evidence may be used
to help make a judgement on capability.
ACAT Acute care assessment ALS Advanced Life Support

tool
CbD Case-based discussion DOPS Direct observation of procedural
Logbook of cases skills
Minutes of an MDT Log of procedures performed
meeting
GCP Good Clinical Practice
Evidence of application
for ethical and R&D
approval
Mini-CEX Mini-clinical evaluation MCR Multiple consultant report
exercise End of placement reports
Educational supervisor’s report
Simulation Simulation training with Clinical supervisor’s report
assessment
project assessment tool Student feedback
Certificates and diplomas in teaching
Teaching material e.g. slides, e-
modules, and podcasts.
Mini-IPX Mini Imaging Interpretation Tool
Reflective Evidence of literature search and

notes critical appraisal of research
Letters generated at outpatient
clinics
End of life care assessment
Mental capacity assessment
Safeguarding assessment
Reflections on regional training
days.
Mortality and morbidity notes
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Blueprint for WPBAs mapped to CiPs
Learning outcomes
ACAT
CbD
DOPS
MCR
Mini -CEX
MSF
PS
QIPAT
TO
Mini-IPX
Generic CiPs
Able to function successfully within NHS √ √
organisational and management systems
Able to deal with ethical and legal issues √ √ √ √ √
related to clinical practice
Communicates effectively and is able to share √ √ √
decision making, while maintaining
appropriate situational awareness,
professional behaviour and professional
judgement
Is focused on patient safety and delivers √ √ √
effective quality improvement in patient care
Carrying out research and managing data √ √
appropriately
Acting as a clinical teacher and clinical √ √ √
supervisor
Clinical CiPs
Managing an acute unselected take √ √ √ √
Managing the acute care of patients within a √ √ √ √

medical specialty service
Providing continuity of care to medical √ √ √ √ √
inpatients, including management of
Managing patients in an outpatient clinic, √ √ √ √
ambulatory or community setting, including
management of long term conditions
Managing medical problems in patients in √ √ √
other specialties and special cases
Managing a multidisciplinary team including √ √ √
effective discharge planning
Delivering effective resuscitation and √ √ √ √
managing the acutely deteriorating patient
Managing end of life and applying palliative √ √ √ √
care skills
Practical procedural skills √
Neurology CiPs
Managing disorders of cognition and √ √ √ √ √ √
consciousness
Page 61 of 70
Learning outcomes
ACAT
CbD
DOPS
MCR
Mini -CEX
MSF
PS
QIPAT
TO
Mini-IPX
Managing headache and pain √ √ √ √ √ √ √
Managing seizures and epilepsy √ √ √ √ √ √
Managing inflammatory and infectious √ √ √ √ √ √ √
disorders
Managing movement disorders √ √ √ √ √ √
Managing neuromuscular disorders √ √ √ √ √ √
Managing traumatic brain injury and patients √ √ √ √ √ √ √
requiring neurorehabilitation
Managing neuropsychiatric disorders, √ √ √ √ √ √
including functional disorders
Learning outcomes
ACAT
CbD
DOPS
MCR
Mini -CEX
MSF
PS
QIPAT
TO
Mini-IPX
Stroke Specialty CiPs
Managing the care of acute stroke √ √ √ √ √ √ √
patients, including hyperacute care and
cerebral reperfusion strategies
Managing the primary and secondary √ √ √ √ √ √ √ √
prevention of stroke and Transient
Ischaemic Attack
Managing early and late stroke √ √ √ √ √ √
rehabilitation in hospital and community
settings
Knowledge based assessment (SCE)

The 100 questions of the Specialty Specific Exam will cover the 8 Neurology CiPs and the 3
Stroke CiPs.
6 Supervision and feedback
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This section of the curriculum describes how trainees will be supervised, and how they will
receive feedback on performance. For further information please refer to the AoMRC
guidance on Improving feedback and reflection to improve learning (9).
Access to high quality, supportive and constructive feedback is essential for the professional
development of the trainee. Trainee reflection is an important part of the feedback process
and exploration of that reflection with the trainer should ideally be a two way dialogue.
Effective feedback is known to enhance learning and combining self-reflection to feedback
promotes deeper learning.
Trainers should be supported to deliver valuable and high quality feedback. This can be by
providing face to face training to trainers. Trainees would also benefit from such training as
they frequently act as assessors to junior doctors, and all involved could also be shown how
best to carry out and record reflection.
6.1 Supervision
All elements of work in training posts must be supervised with the level of supervision
varying depending on the experience of the trainee and the clinical exposure and case mix
undertaken. Outpatient and referral supervision must routinely include the opportunity to
discuss all cases with a supervisor if appropriate. As training progresses the trainee should
have the opportunity for increasing autonomy, consistent with safe and effective care for
the patient.
Organisations must make sure that each doctor in training has access to a named clinical
supervisor and a named educational supervisor. Depending on local arrangements these
roles may be combined into a single role of educational supervisor. However, it is preferred
that a trainee has a single named educational supervisor for (at least) a full training year, in
which case the clinical supervisor is likely to be a different consultant during some
placements.
The role and responsibilities of supervisors have been defined by the GMC in their standards
for medical education and training (10)
Educational supervisor
The educational supervisor is responsible for the overall supervision and management of a
doctor’s educational progress during a placement or a series of placements. The educational
supervisor regularly meets with the doctor in training to help plan their training, review
progress and achieve agreed learning outcomes. The educational supervisor is responsible
for the educational agreement, and for bringing together all relevant evidence to form a
summative judgement about progression at the end of the placement or a series of
placements. Trainees on a dual training program may have a single educational supervisor
responsible for their internal medicine and specialty training, or they may have two
educational supervisors, one responsible for internal medicine and one for specialty.
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Clinical supervisor
Consultants responsible for patients that a trainee looks after provide clinical supervision for
that trainee and thereby contribute to their training; they may also contribute to
assessment of their performance by completing a ‘Multiple Consultant Report (MCR)’ and
other WPBAs. A trainee may also be allocated (for instance, if they are not working with
their educational supervisor in a particular placement) a named clinical supervisor, who is
responsible for reviewing the trainee’s training and progress during a particular placement.
It is expected that a named clinical supervisor will provide a MCR for the trainee to inform
the Educational Supervisor’s report.
The educational and (if relevant) clinical supervisors, when meeting with the trainee, should
discuss issues of clinical governance, risk management and any report of any untoward
clinical incidents involving the trainee. If the service lead (clinical director) has any concerns
about the performance of the trainee, or there are issues of doctor or patient safety, these
would be discussed with the clinical and educational supervisors (as well as the trainee).
These processes, which are integral to trainee development, must not detract from the
statutory duty of the trust to deliver effective clinical governance through its management
systems.
Educational and clinical supervisors need to be formally recognised by the GMC to carry out
their roles (11). It is essential that training in assessment is provided for trainers and
trainees in order to ensure that there is complete understanding of the assessment system,
assessment methods, their purposes and use. Training will ensure a shared understanding
and a consistency in the use of the WPBAs and the application of standards.
Opportunities for feedback to trainees about their performance will arise through the use of
the workplace-based assessments, regular appraisal meetings with supervisors, other
meetings and discussions with supervisors and colleagues, and feedback from ARCP.
Trainees
Trainees should make the safety of patients their first priority and they should not be
practising in clinical scenarios which are beyond their experience and capability without
supervision. Trainees should actively devise individual learning goals in discussion with their
trainers and should subsequently identify the appropriate opportunities to achieve said
learning goals. Trainees would need to plan their WPBAs accordingly to enable their WPBAs
to collectively provide a picture of their development during a training period. Trainees
should actively seek guidance from their trainers in order to identify the appropriate
learning opportunities and plan the appropriate frequencies and types of WPBAs according
to their individual learning needs. It is the responsibility of trainees to seek feedback
following learning opportunities and WPBAs. Trainees should self-reflect and self-evaluate
regularly with the aid of feedback. Furthermore, trainees should formulate action plans with
further learning goals in discussion with their trainers.
6.2 Appraisal
A formal process of appraisals and reviews underpins training. This process ensures
adequate supervision during training, provides continuity between posts and different
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supervisors and is one of the main ways of providing feedback to trainees. All appraisals
should be recorded in the eportfolio
Induction Appraisal
The trainee and educational supervisor should have an appraisal meeting at the beginning
of each post to review the trainee’s progress so far, agree learning objectives for the post
ahead and identify the learning opportunities presented by the post. Reviewing progress
through the curriculum will help trainees to compile an effective Personal Development Plan
(PDP) of objectives for the upcoming post. This PDP should be agreed during the Induction
Appraisal. The trainee and supervisor should also both sign the educational agreement in
the e-portfolio at this time, recording their commitment to the training process.
Mid-point Review
This meeting between trainee and educational supervisor is not mandatory (particularly
when an attachment is shorter than 6 months) but is encouraged particularly if either the
trainee or educational or clinical supervisor has training concerns or the trainee has been
set specific targeted training objectives at their ARCP). At this meeting trainees should
review their PDP with their supervisor using evidence from the e-portfolio. Workplace-
based assessments and progress through the curriculum can be reviewed to ensure trainees
are progressing satisfactorily, and attendance at educational events should also be
reviewed. The PDP can be amended at this review.
End of Attachment Appraisal

Trainees should review the PDP and curriculum progress with their educational supervisor
using evidence from the e-portfolio. Specific concerns may be highlighted from this
appraisal. The end of attachment appraisal form should record the areas where further
work is required to overcome any shortcomings. Further evidence of competence in certain
areas may be needed, such as planned workplace-based assessments, and this should be
recorded. If there are significant concerns following the end of attachment appraisal then
the programme director should be informed. Supervisors should also identify areas where a
trainee has performed about the level expected and highlight successes.
7 Quality Management
The organisation of training programs is the responsibility of the deaneries. The deaneries
will oversee programmes for postgraduate medical training in their regions. The Schools of
Medicine in England, Wales and Northern Ireland and the Medical Specialty Training Board
in Scotland will undertake the following roles:
• oversee recruitment and induction of trainees into the specialty
• allocate trainees into particular rotations appropriate to their training needs
• oversee the quality of training posts provided locally
• ensure adequate provision of appropriate educational events
• ensure curricula implementation across training programmes
• oversee the workplace-based assessment process within programmes
• coordinate the ARCP process for trainees
• provide adequate and appropriate career advice
• provide systems to identify and assist doctors with training difficulties
Page 65 of 70
• provide flexible training.
Educational programmes to train educational supervisors and assessors in workplace based

assessment may be delivered by deaneries or by the colleges or both.
Development, implementation, monitoring and review of the curriculum are the

responsibility of the JRCPTB and the SAC. The committee will be formally constituted with
representatives from each health region in England, from the devolved nations and with
trainee and lay representation. It will be the responsibility of the JRCPTB to ensure that
curriculum developments are communicated to heads of school, regional specialty training
committees and TPDs.
The JRCPTB has a role in quality management by monitoring and driving improvement in the
standard of all medical specialties on behalf of the three Royal Colleges of Physicians in
Edinburgh, Glasgow and London. The SACs are actively involved in assisting and supporting
deaneries to manage and improve the quality of education within each of their approved
training locations. They are tasked with activities central to assuring the quality of medical
education such as writing the curriculum and assessment systems, reviewing applications
for new posts and programmes, provision of external advisors to deaneries and
recommending trainees eligible for CCT or Certificate of Eligibility for Specialist Registration
(CESR).
JRCPTB uses data from six quality datasets across its specialties and subspecialties to
provide meaningful quality management. The datasets include the GMC national Training
Survey (NTS) data, ARCP outcomes, examination outcomes, new consultant survey, external
advisor reports and the monitoring visit reports.
Quality criteria have been developed to drive up the quality of training environments and
ultimately improve patient safety and experience. These are monitored and reviewed by
JRCPTB to improve the provision of training and ensure enhanced educational experiences.
8 Intended use of curriculum by trainers and trainees
This curriculum and ARCP decision aid are available from the Joint Royal Colleges of
Physicians Training Board (JRCPTB) via the website www.jrcptb.org.uk.
Clinical and educational supervisors should use the curriculum and decision aid as the basis
of their discussion with trainees, particularly during the appraisal process. Both trainers and
trainees are expected to have a good knowledge of the curriculum and should use it as a
guide for their training programme.
Each trainee will engage with the curriculum by maintaining an eportfolio. The trainee will
use the curriculum to develop learning objectives and reflect on learning experiences.
Recording progress in the eportfolio
Page 66 of 70
On enrolling with JRCPTB trainees will be given access to the eportfolio. The eportfolio
allows evidence to be built up to inform decisions on a trainee’s progress and provides tools
to support trainees’ education and development.
The trainee’s main responsibilities are to ensure the eportfolio is kept up to date, arrange
assessments and ensure they are recorded, prepare drafts of appraisal forms, maintain their
personal development plan, record their reflections on learning and record their progress
through the curriculum.
The supervisor’s main responsibilities are to use eportfolio evidence such as outcomes of
assessments, reflections and personal development plans to inform appraisal meetings.
They are also expected to update the trainee’s record of progress through the curriculum,
write end-of-attachment appraisals and supervisor’s reports.
Deaneries, training programme directors, college tutors and ARCP panels may use the
eportfolio to monitor the progress of trainees for whom they are responsible.
JRCPTB will use summarised, anonymous eportfolio data to support its work in quality
assurance.
All appraisal meetings, personal development plans and workplace based assessments
(including MSF) should be recorded in the eportfolio. Trainees are encouraged to reflect on
their learning experiences and to record these in the eportfolio. Reflections can be kept
private or shared with supervisors.
Reflections, assessments and other eportfolio content should be used to provide evidence
towards acquisition of curriculum capabilities. Trainees should add their own self-
assessment ratings to record their view of their progress. The aims of the self-assessment
are:
• to provide the means for reflection and evaluation of current practice
• to inform discussions with supervisors to help both gain insight and assists in developing
personal development plans.
• to identify shortcomings between experience, competency and areas defined in the
curriculum so as to guide future clinical exposure and learning.
Supervisors can sign-off and comment on curriculum capabilities to build up a picture of

progression and to inform ARCP panels.
9 Equality and Diversity
The Royal Colleges of Physicians will comply, and ensure compliance, with the requirements
of equality and diversity legislation set out in the Equality Act 2010 (12).
The Federation of the Royal Colleges of Physicians believes that equality of opportunity is
fundamental to the many and varied ways in which individuals become involved with the
Colleges, either as members of staff and Officers; as advisers from the medical profession;
Page 67 of 70
as members of the Colleges' professional bodies or as doctors in training and examination
candidates.
Deaneries quality assurance will ensure that each training programme complies with the
equality and diversity standards in postgraduate medical training as set by GMC. They
should provide access to a professional support unit or equivalent for trainees requiring
additional support.
Compliance with anti-discriminatory practice will be assured through:

• monitoring of recruitment processes
• ensuring all College representatives and Programme Directors have attended
appropriate training sessions prior to appointment or within 12 months of taking up post
• Deaneries ensuring that educational supervisors have had equality and diversity training
(for example, an e-learning module) every three years
• Deaneries ensuring that any specialist participating in trainee interview/appointments
committees or processes has had equality and diversity training (at least as an e-
module) every three years
• ensuring trainees have an appropriate, confidential and supportive route to report
examples of inappropriate behaviour of a discriminatory nature. Deaneries and
Programme Directors must ensure that on appointment trainees are made aware of the
route in which inappropriate or discriminatory behaviour can be reported and supplied
with contact names and numbers. Deaneries must also ensure contingency mechanisms
are in place if trainees feel unhappy with the response or uncomfortable with the
contact individual
• providing resources to trainees needing support (for example, through the provision of a
professional support unit or equivalent)
• monitoring of College Examinations
• ensuring all assessments discriminate on objective and appropriate criteria and do not
unfairly advantage or disadvantage a trainee with any of the Equality Act 2010 protected
characteristics. All efforts shall be made to ensure the participation of people with a
disability in training through reasonable adjustments.
References
1 https://www.neural.org.uk/about-neurological-conditions/
2 https://www.sueryder.org/sites/default/files/2019-07/neuro-patience-2019.pdf
3 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/at
tachment_data/file/683860/Deaths_associated_with_neurological_conditions_d
ata_analysis_report.pdf
4 https://www.nature.com/articles/s41582-018-0036-5
5 https://www.copmed.org.uk/gold-guide-8th-edition/
6 https://www.gmc-uk.org/education/standards-guidance-and-
curricula/standards-and-outcomes/generic-professional-capabilities-framework
7 https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-
medical-practice
8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3613304/
Page 68 of 70
9 https://www.aomrc.org.uk/reports-guidance/improving-feedback-reflection-
improve-learning-practical-guide-trainees-trainers/
10 https://www.gmc-uk.org/education/standards-guidance-and-
curricula/standards-and-outcomes/promoting-excellence
11 https://www.gmc-uk.org/education/how-we-quality-assure/postgraduate-bodie
12 https://www.legislation.gov.uk/ukpga/2010/15/contents
Page 69 of 70
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Curriculum for Neurology Training

Implementation August 2022

2.1 High level learning outcomes – Capabilities in Practice (CiPs) ............................................... 5

2.1 Purpose of the curriculum

2.2 High level learning outcomes – Capabilities in Practice (CiPs)

Following the successful completion of a training programme in neurology, a doctor will be

Learning outcomes – Capabilities in Practice (CiPs)

Clinical CiPs (Internal Medicine)

2.3 Training pathway

2.4 Duration of training

2.5 Flexibility and accreditation of transferable capabilities

2.6 Less than full time training (LTFT)

3.1 Capabilities in Practice (CiPs)

3.2 Generic Capabilities in Practice

• Professional behaviour and trust

ACAT Acute care assessment tool ALS Advanced Life Support

Generic capabilities in practice (CiPs)

Category 1: Professional behaviour and trust

Descriptors • Aware of and adheres to the GMC professional requirements

Descriptors • Aware of national legislation and legal responsibilities, including

Category 3: Safety and quality

Descriptors • Manages clinical information/data appropriately

Descriptors • Delivers effective teaching and training to medical students, junior

Clinical CiPs – Internal Medicine

1. Managing an acute unselected take

Descriptors • Demonstrates professional behaviour with regard to patients, carers,

Descriptors • Able to manage patients who have been referred acutely to a

Descriptors • Demonstrates effective consultation skills (including when in

Descriptors • Applies management and team working skills appropriately, including

Descriptors • Demonstrates prompt assessment of the acutely deteriorating patient,

Descriptors • Identifies patients with limited reversibility of their medical condition

3.4 Specialty Capabilities in Practice (CiPs)

Able to write a history by consulting all relevant sources, including

Able to examine patients using appropriate techniques and rating scales.

Able to select, request and interpret relevant investigations to inform

Able to work independently and as part of a multidisciplinary team to

Able to anticipate, recognise and manage complications in accordance

Able to work with and appropriately refer to other relevant

GPCs Domain 1: Professional values and behaviours

Able to write a history by consulting all relevant sources, including

Able to examine patients using appropriate techniques and rating scales.

Able to work independently and as part of a multidisciplinary team to

Able to anticipate, recognise and manage complications including the

Able to work with and appropriately refer to other relevant

GPCs Domain 1: Professional values and behaviours

Able to write a history by consulting all relevant sources in order to

Able to select, request and interpret investigations including ECG, EEG

Able to work independently and as part of a multidisciplinary team to

Able to anticipate, recognise and manage complications including the

Able to work with and appropriately refer to other relevant

GPCs Domain 1: Professional values and behaviours

4. Managing inflammatory and infectious disorders

Able to write a history by consulting all relevant sources to include past

Able to examine patients using appropriate techniques and rating scales.

Able to select, request and interpret relevant investigations including

Able to work independently and as part of a multidisciplinary team to

Able to anticipate, recognise and manage complications of the disease

Able to work with and appropriately refer to other relevant

GPCs Domain 1: Professional values and behaviours