Development of a GMC aligned curriculum for internal medicine including a qualitative study of the acceptability of 'capabilities in practice' as a curriculum model.

The Shape of Training review and the General Medical Council (GMC) requirements in demonstrating generic professional capabilities were major drivers for the Joint Royal Colleges of Physicians Training Board (JRCPTB) to develop the new internal medicine curriculum. In particular, the GMC required progression to a more outcomes-based curriculum. The present curricula for physician training are based on demonstrating a large number of individual competencies that are assessed by a variety of different methods. It was felt that current system was overwhelming and had become a 'tick box' exercise. The new curriculum is based on a much smaller number of outcomes, called capabilities in practice, which reflect the key professional work activities of a fully trained physician. The aim is to re-emphasise the role of professional judgement in 'trusting' the work a trainee does and thus make assessment more realistic and meaningful for both trainees and trainers. The proof of concept study explored the feasibility of using this outcomes-based model of assessment in a UK NHS setting. The learning from the study has enabled us to make significant changes to the internal medicine curriculum. The GMC has recently approved the curriculum and the JRCPTB is implementing the programme from August 2019.

Time-of-flight PET/CT using low-activity protocols: potential implications for cancer therapy monitoring.

INTRODUCTION: Accurate quantification of tumour tracer uptake is essential for therapy monitoring by sequential PET imaging. In this study we investigated to what extent a reduction in administered activity, synonymous with an overall reduction in repeated patient exposure, compromised the accuracy of quantitative measures using time-of-flight PET/CT. METHODS: We evaluated the effect of reducing the emission count statistics, using a 64-channel GEMINI TF PET/CT system. Experiments were performed with the NEMA IEC body phantom at target-to-background ratios of 4:1 and 10:1. Emission data for 10 s, 30 s, 1 min, 2 min, 5 min and 30 min were acquired. Volumes of interest fitted to the CT outline of the spheres were used to calculate recovery coefficients for each target-to-background ratio and for different reconstruction algorithms. Whole-body time-of-flight PET/CT was performed in 20 patients 62+/-4 min after injection of 350+/-40 MBq (range 269-411 MBq) (18)F-FDG. From the acquired 2 min per bed position list mode data, simulated 1-min, 30-s and 15-s PET acquisitions were created. PET images were reconstructed using the TOF-OSEM algorithm and analysed for differences in SUV measurements resulting from the use of lower administered activity as simulated by reduced count statistics. RESULTS: In the phantom studies, overall we identified no significant quantitation bias over a wide range of acquired counts. With acquisition times as short as 10 s, lesions as small as 1 cm in diameter could still be identified. In the patient studies, visual analysis showed that emission scans as short as 15 s per bed position sufficiently identified tumour lesions for quantification. As the acquisition time per bed position decreased, the differences in SUV quantification of tumour lesions increased relative to the 2-min reference protocol. However, SUVs remained within the limits of reproducibility required for therapy monitoring. Measurements of SUVmean within the region of interest were less prone to noise than SUVmax, and with the 30-s per bed position 95% confidence limits were +/-11% or +/-0.7 SUV. CONCLUSION: Short time acquisitions, synonymous with reduced injected activity, performed on a TOF-based PET/CT system are feasible without encountering significant bias. This could translate into clinical protocols using lower administered activities particularly for serial PET studies.