RCPI General Internal Medicine Update: A comprehensive two-day course

In March, the RCPI is hosting a practical programme for consultants and specialist registrars who work on busy on-call rotas in general internal medicine

For consultants and specialist registrars (SpRs) on busy general internal medicine (GIM) on-call rotas, acute, and inpatient care is challenging, unpredictable, and covers multiple specialties. Managing unselected admissions demands a strong grounding in core medical principles and the confidence to apply the latest evidence in everyday clinical practice.

To support consultants and SpRs navigating these demands, the RCPI’s Institute of Medicine is hosting the General Internal Medicine Update 2026, a two-day, practical programme designed specifically for consultants and SpRs working on busy on-call rotas. The update focuses on the most common conditions, presentations, and management decisions in acute and inpatient care, providing guidance that can be applied directly at the bedside.

Central role

GIM plays a central and demanding role in hospital care. As patient populations age and multimorbidity becomes more common, the breadth of knowledge required to deliver safe and effective care has expanded significantly. GIM physicians routinely manage acute presentations across cardiology, nephrology, respiratory medicine, infectious disease, geriatrics, and neurology, often simultaneously. Furthermore, they must do so while navigating service demands and constrained resources.

In this context, maintaining up-to-date clinical knowledge across specialties is crucial and forms a core part of patient safety. Even as subspecialisation continues to advance, confident generalist decision-making remains at the heart of acute medical care. The challenge is keeping this broad knowledge up-to-date while evidence, guidelines, and treatments continue to change rapidly. Maintaining this breadth of knowledge has never been more important.

Chair of the General Internal Medicine Update 2026, Dr Sam Kant, Consultant Nephrologist, St Vincent’s University Hospital, Dublin, says the programme is designed around the realities of GIM on-call work. “General internal medicine is where complexity meets urgency. On call, clinicians manage a wide range of acute presentations, often in patients with multiple health conditions. In addition, success in clinical research has resulted in a plethora of information, with ever-evolving guidelines in multiple realms of general internal medicine. This meeting was created to reflect that reality and consolidate this rapid increase in information.”

Rather than attempting to cover every subspecialty in depth, the programme focuses on the conditions, presentations, and management decisions most commonly encountered by GIM on-call teams. Throughout the two-day update, the emphasis is on clinical relevance and how it can be applied.

“We focused on topics that GIM physicians actually encounter day-to-day and providing practical updates that support confident, evidence-based decision-making at the bedside,” he says.

Experts

Over two days, the programme brings together experts from across the major subspecialties to deliver focused presentations, guideline updates, pharmacotherapy developments, and case-based discussions. The aim is to help clinicians navigate what has changed, what matters most, and how to apply evolving evidence in real-world GIM on-call practice.

The programme opens with cardiology, reflecting the central role cardiovascular disease continues to play in acute medical admissions. Sessions on contemporary heart failure management and evolving approaches to atrial fibrillation and common arrhythmias will address areas where therapeutic advances and guideline updates have had a direct impact on inpatient care.

Respiratory medicine also forms a key component of the programme with updates on chronic obstructive pulmonary disease, asthma, and pulmonary embolism. These sessions will explore new developments in management and highlight practical considerations for acute and inpatient settings.

Next is geriatric medicine with a focus on recognising and managing delirium and optimising prescribing in older adults. These topics are relevant across all specialties, especially as clinicians care for patients with frailty, multiple medications, and cognitive impairment.

Rheumatology and nephrology sessions cover conditions that often challenge GIM teams, such as gout, hyponatraemia, and hypertensive emergencies. By reviewing both the established principles and the recent evidence and guidelines, these sessions aim to help clinicians make confident, timely decisions in acute settings.

Infectious disease rounds off the first day, with updates on managing pneumonia and urinary tract infections, and a discussion on the duration of antibiotic courses including generalised versus personalised approaches.

Endocrinology sessions will address inpatient diabetes management and diabetic ketoacidosis, alongside updates in anti-obesity therapeutics, reflecting the rapid pace of change in metabolic medicine and its implications for inpatient care.

The programme concludes with neurology and gastroenterology including sessions on seizure versus syncope, stroke, and stroke mimics, acute liver injury and cirrhosis management, and the investigation of diarrhoea with updates on common causes.

“GIM touches many areas of medicine. A focused update like this helps clinicians keep a broad perspective while staying up-to-date with current standards of care,” adds Dr Kant.

Plenary address

A highlight of the meeting will be the plenary address from Dr Jason Goldman, President of the American College of Physicians (ACP), who will speak on ‘Challenges and solutions in the practice of general internal medicine’. Dr Goldman, a board-certified internist with over 20 years’ experience, brings insight from both clinical practice and medical leadership to challenges facing healthcare today.

Reflecting on what he hopes participants will take from his plenary, Dr Goldman points to the pressures within healthcare that are affecting everyday medical practice.

“I would like participants to have an understanding of the unique nature of the US healthcare system and how the various challenges occur from a decreasing physician workforce, lack of adequate coverage and access, excessive cost, misinformation, and political interference with information and care delivery,” he says.

While healthcare systems differ around the world, clinicians working in the Irish healthcare system will be familiar with many of these shared pressures including constrained resources, increasing patient complexity, and rising demand. From Dr Goldman’s perspective as ACP President, this makes staying current more important than ever.

“One of the greatest challenges we face is an over-complex and underfunded healthcare system that discourages physicians from entering primary care. Low payment structures make many practices unsustainable while excessive administrative burden creates obstacles to access and care delivery,” he notes.

For clinicians working on busy GIM rotas, Dr Goldman emphasises that maintaining safe, evidence-based care will require evolving approaches to decision-making.

“Physicians will need to integrate real-time resources into inpatient care decisions to ensure up-to-the-minute recommendations. Technology will have to be leveraged, including the appropriate use of vetted AI [artificial intelligence] within secure systems,” he says.

He also highlights the importance of clinician wellbeing, noting that effective time management and attention to personal health are essential to avoid burnout and moral injury.

Asked whether there are lessons from international practice that may be particularly relevant to GIM physicians in Ireland, Dr Goldman reflects on a central guiding principle: “One of my mantras is to always focus on what is best for the patient and continue to be their advocate in all things. The patient as the North Star is the centre of all good decisions.”

Beyond this philosophy, Dr Goldman emphasises the importance of efficient systems and effective teamwork, which he has learned from decades in solo and small-group practice.

“Putting reproducible systems in place and ensuring teams are well trained and adaptable is critical for delivering consistent, effective care,” he says.

Dr Goldman’s perspectives support the broader aims of the General Internal Medicine Update to both update clinical knowledge and to support sustainable practice and service delivery in increasingly complex healthcare environments.

Attendees will have access to presentations and session recordings for six months after the meeting, allowing them to revisit content and apply updates at their own pace, which is an important benefit for those balancing learning with clinical commitments.

A comprehensive, practical update across all major GIM subspecialties, the General Internal Medicine Update 2026 equips consultants and SpRs to make confident, evidence-based decisions in everyday on-call practice.

This article was produced by the RCPI.