Your first steps in Acute Medicine
See the patient. Understand the presentation. Learn the decision.
Acute Medicine offers medical students a unique opportunity to understand how adults who suddenly become unwell are assessed, investigated and treated in hospital.
Whether you are preparing for your first placement, developing clinical skills or exploring a future career, SAM's undergraduate syllabus will help you understand what to learn and how to make the most of the experience.
Discover the clinical presentations, emergencies, practical skills and decision-making that make Acute Medicine such a fascinating specialty.
Free affiliated SAM membership for eligible medical students.
Acute Internal Medicine
The Society for Acute Medicine's undergraduate syllabus provides a framework for learning about the assessment and management of acutely unwell medical patients.
Version 1 · December 2023
Review scheduled December 2028
What is Acute Medicine?
Acute Medicine is the hospital specialty that provides urgent assessment, investigation and treatment for adults who suddenly become unwell with a medical illness (rather than for an injury or surgical problem), usually during the first few days of care. Most patients are referred by their GP, a community healthcare team or the Emergency Department.
Emergency Department
Emergency Medicine assesses and stabilises patients with a wide range of urgent presentations, including medical, surgical and injury-related problems.
Acute Medicine
The Acute Medicine team investigates and treats adults with acute medical illness. This involves early diagnostic decisions, senior review, treatment and deciding the most appropriate onward care.
Other specialist teams
Patients needing further specialist treatment may move to cardiology, respiratory medicine, gastroenterology or another relevant service, with continued multidisciplinary care.
Acute Medical Unit (AMU)
The main hospital setting for assessment, investigation, treatment and early care of acutely unwell medical patients.
Medical SDEC
Same Day Emergency Care can provide urgent specialist assessment and treatment, avoiding overnight admission for appropriately selected patients.
Explore SDEC →Enhanced Care
Some medical patients need closer observation and enhanced treatment beyond routine ward care, with clear escalation arrangements.
Explore Enhanced Care →Get ready for your Acute Medicine placement
An acute medical placement is an opportunity to take part in real clinical care, learn from different professionals and see how decisions are made throughout a patient's hospital journey.
Learning happens at the bedside
Acute Medicine offers opportunities to understand the patient journey, participate in supervised clinical assessments and learn directly from experienced clinicians.
Be curious, ask questions and seek feedback. Some of the most valuable learning comes from understanding why a clinical team made a particular decision.
Bedside learning should always respect patient choice, consent, privacy and dignity.
Before you start
- Review your medical school's placement objectives.
- Read SAM's undergraduate syllabus.
- Revise ABCDE assessment and common presentations.
- Confirm your induction, timetable and supervisor.
- Review confidentiality and patient safety.
During your placement
- Introduce yourself to the clinical team.
- Join AMU ward rounds and the acute medical take.
- Clerk patients with appropriate supervision.
- Observe medical SDEC and discharge decisions.
- Seek feedback on clinical reasoning.
Before you finish
- Review your learning objectives.
- Reflect on interesting clinical presentations.
- Request feedback on clinical skills.
- Complete your university's required assessments.
- Identify areas for further development.
What you should expect
You should receive an appropriate induction, understand who supervises your work, be welcomed into the clinical team and have opportunities to participate in activities suitable for your stage of training.
You should know how to access feedback, wellbeing support, reasonable adjustments and routes for raising concerns.
GMC: What to expect on placement →What your team will expect
Respect for patients and colleagues, professional behaviour, punctuality, engagement with learning and an awareness of your limitations.
Always obtain appropriate patient consent and ask for supervision before undertaking clinical skills.
If you recognise a deteriorating patient, seek appropriate clinical help immediately.
Explore the SAM undergraduate syllabus
From understanding the acute medical take to recognising emergencies, the syllabus helps you connect undergraduate learning with everyday Acute Medicine.
The SAM syllabus describes the range of acute medical presentations, clinical knowledge and skills relevant to students and undergraduate educators.
It is intended as guidance towards the knowledge expected of a non-specialist Foundation doctor, rather than a replacement for your medical school's approved curriculum.
Acute medical care
How Acute Medicine works, clinical assessment, multidisciplinary care, escalation and patient pathways.
Clinical presentations
Diagnostic reasoning, common presenting symptoms and underlying medical conditions.
Medical emergencies
Recognising and understanding the immediate management of 15 important acute medical emergency groups.
Skills and procedures
Practical skills that students may perform under supervision and procedures they may observe.
Turn the syllabus into learning
Expand each area to explore the learning objectives, relevant placement opportunities and questions worth discussing with a supervising clinician.
01. Generic aspects of Acute Internal Medicine
What should I understand?
- The role of Acute Medicine and the Acute Medical Unit.
- How the acute medical take is organised.
- The ABCDE approach to assessing an acutely unwell patient.
- Diagnostic reasoning, investigations and recognising cognitive bias.
- Escalation, resuscitation and individualised treatment ceilings.
- Prescribing and fluid management in acute illness.
- Patient flow, multidisciplinary working and discharge planning.
- The interfaces between Acute Medicine, SDEC, critical care and other specialties.
What might I experience on placement?
- Attend an acute medical handover.
- Join consultant-led AMU rounds.
- Observe how patients are selected for medical SDEC.
- See investigations and treatment decisions being made.
- Discuss discharge and onward referral decisions.
Ask your supervisor
What makes this patient suitable for AMU, SDEC, specialist inpatient care or critical care?
What information was most important in making that decision?
02. Presentations and conditions
What should I understand?
The syllabus asks students to develop an appropriate diagnostic strategy and justified differential diagnoses for a broad range of presentations.
It also covers the underlying pathophysiology and treatment options for associated conditions.
Examples of presentations
- Chest pain and breathlessness
- Abdominal pain and vomiting
- Delirium and confusion
- Syncope and collapse
- Acute kidney injury
- Fever and suspected infection
- Electrolyte disturbances
- Palpitations and arrhythmias
- Seizures and neurological symptoms
- Falls and weakness
What might I experience on placement?
- Clerk a patient under appropriate supervision.
- Construct a differential diagnosis.
- Discuss investigations and their interpretation.
- Present your findings to a supervising clinician.
Ask your supervisor
What were the key differential diagnoses? Which investigation was most useful?
What clinical finding would have changed the management plan?
03. Recognising medical emergencies
What should I understand?
The syllabus identifies 15 emergency presentation groups for which students should be able to describe immediate management.
- Anaphylaxis
- Acute asthma
- Acute coronary syndromes
- Acute poisoning
- Adrenal crisis
- DKA and HHS
- Exacerbation of COPD
- Meningitis / encephalitis
- Pneumothorax
- Pulmonary embolism
- Pulmonary oedema
- Sepsis
- Shock
- Status epilepticus
- Upper GI haemorrhage
What might I experience on placement?
- ABCDE assessment during supervised clinical teaching.
- Simulation of an acutely deteriorating patient.
- Discussion of resuscitation and escalation decisions.
- Observation of acute emergency care when appropriate and safe.
Ask your supervisor
What features indicate immediate danger? Who should be called for help?
What is the initial assessment and how is response to treatment monitored?
04. Clinical skills and procedures
Skills you may have opportunities to perform
Depending on training, supervision, consent and local requirements:
- Capillary blood glucose measurement
- Urinalysis
- Blood culture sampling
- Peak expiratory flow measurement
- ECG recording and interpretation
- Handling blood samples
Procedures you may observe
- Lumbar puncture
- Central venous access
- Blood transfusion procedures
- Point-of-care ultrasound and echocardiography
- Intravenous fluid administration
- Respiratory investigations and inhaled device teaching
What might I experience on placement?
Ask your supervising team about appropriate opportunities to practise, observe and receive feedback.
Ask your supervisor
What are the indications, contraindications and potential complications of this procedure?
What level of supervision would I need to participate safely?
You must work within your competence, obtain appropriate patient consent and follow local supervision requirements.
For undergraduate educators and placement supervisors
The SAM syllabus offers a shared framework for undergraduate teaching in Acute Medicine.
It can help structure teaching around acute presentations, diagnostic reasoning, deterioration, patient pathways and practical skills.
The syllabus complements local university curricula and required assessments.
Using the syllabus in teaching
- Map local learning outcomes to the SAM syllabus.
- Structure bedside teaching around common presentations.
- Use simulation for emergency presentations.
- Encourage clinical reasoning discussions and feedback.
- Identify opportunities to observe or practise relevant skills.
Version 1 · December 2023 · 11 pages
Learn from the presentations you see
Acute Medicine often begins with a symptom, not a diagnosis. Clinical reasoning involves recognising important possibilities, identifying immediate risks and using investigations appropriately.
From investigation to clinical decision
Learning to interpret investigations is about more than recognising an abnormality.
It involves understanding the patient's presentation and deciding how new information changes your differential diagnosis.
Discuss ECGs, blood results and imaging with your supervising clinician. Practise explaining what each finding means in its clinical context.
Five questions to ask about any case
- What brought the patient to hospital?
- What could make this presentation dangerous?
- What are the most important differentials?
- What investigations would help, and why?
- What influenced the decision to admit, use SDEC or discharge?
Turn a patient encounter into learning
Ask a supervisor to explain a clinical decision. Practise presenting a concise assessment and compare your differential diagnoses with the team's reasoning.
Consider how symptoms, observations, comorbidities, patient preferences and social circumstances affected the overall management plan.
These are educational prompts, not clinical management instructions. Real patient decisions must be made by the responsible clinical team.
My Acute Medicine placement checklist
Turn the SAM undergraduate syllabus into real learning experiences.
These suggested activities are organised around the four areas of SAM's syllabus. Use them to identify learning opportunities, reflect on what you have seen and discuss your progress with supervisors.
You do not need to complete every item. Opportunities depend on your stage of training, placement setting and clinical supervision.
Understanding Acute Medicine
Generic aspects of Acute Internal Medicine
Think about: patient flow, teamwork, clinical responsibility and safe discharge.
Clinical presentations and reasoning
Presentations and conditions in Acute Medicine
Think about: diagnostic strategy, interpretation and avoiding premature conclusions.
Recognising medical emergencies
Emergency presentations and escalation
Think about: recognising danger, seeking senior help and reassessing the patient.
Clinical skills and procedures
Supervised skills and procedural observation
Think about: indications, consent, limitations, safety and supervision.
Reflect on your learning
Before finishing your placement, consider three things:
- Which patient presentation taught me the most?
- What did I learn about clinical decision-making?
- What knowledge or skill would I like to develop next?
Discuss your progress
Ask your supervisor for feedback on your clinical reasoning, patient assessments and practical learning.
Use your medical school's official assessment process to record required competencies and placement outcomes.
Return to the SAM syllabus →This optional checklist is a learning aid, not a formal assessment or competency record. Selections are not submitted to SAM and will normally reset when the page is refreshed. Do not enter or retain identifiable patient information.
Useful learning resources
Build your clinical knowledge using SAM resources, professional guidance and independently developed medical education websites.
These resources supplement your medical school's teaching and current local clinical guidance.
Join the SAM learning community
Medical students can apply for free affiliated SAM membership. Discover the Society's educational resources, news, events and wider Acute Medicine community while you are still at medical school.
Free affiliated membership for eligible students
Learn together: students and Acute Medicine
Some of the most useful learning comes from questions students ask during their placements.
SAM wants to encourage students, clinical educators and Acute Medicine teams to help develop a collection of practical undergraduate learning resources.
Clinical question of the month
Short case-based questions about common medical presentations, with clear educational explanations and supporting references.
Proposed student learning series
Tips from medical students
Practical advice from students who have completed acute medical placements, including learning opportunities and useful ways to participate in clinical teams.
Proposed peer-to-peer resource
One-minute teaching pearls
Short educational contributions covering ECG interpretation, blood gases, diagnostic reasoning, prescribing safety and recognition of deterioration.
Proposed educator-reviewed series
Have an idea for a student resource?
We welcome suggestions from medical students, Acute Medicine clinicians and undergraduate educators.
Ideas could include a useful placement checklist, an original teaching resource, a short educational article or a topic that students regularly find difficult.
Suggest a learning resource →Safe and responsible contributions
Any published student-created material should be educationally reviewed, appropriately referenced and checked for originality, permissions and confidentiality.
Please do not submit identifiable patient details, clinical photographs, screenshots of records or confidential placement information.
This is an invitation for suggestions, not yet a live publication or case-submission programme.
Could Acute Medicine be part of your future?
You do not need to choose your specialty while you are at medical school.
But if you enjoy clinical problem-solving, managing uncertainty, teamwork and caring for adults with acute illness, Acute Medicine is worth exploring.
takeAIM is an initiative promoting Acute Internal Medicine as a career. It includes resources for medical students and Foundation doctors, although much of its wider content is aimed at qualified doctors.
Keep exploring Acute Medicine
Some learning and career resources are aimed at postgraduate doctors and may not yet be appropriate for undergraduate training.
Start your SAM journey while you're at medical school
Become part of the Acute Medicine community before you qualify.
SAM welcomes medical students who want to learn more about Acute Medicine, develop their interests and connect with the wider specialty.
Free affiliated membership gives eligible students an opportunity to engage with SAM's educational resources, news and professional community.
Student membership is free and does not include voting rights. Applications are reviewed by SAM.
Become a student member
Start your free membership application through SAM's existing registration system.
Join SAM for free →No student membership fee