Facing the inevitable: Rethinking medical education for an ageing population

As the NHS faces increasing pressure from an ageing population and rising multimorbidity, Internal Medicine Trainees (IMTs) are required to navigate uncertainty, frailty, and end-of-life decision-making. For many, a geriatric rotation provides the first sustained exposure to patients for whom cure is unrealistic and goals of care are complex. This opinion piece examines how geriatric training reshapes trainee attitudes towards investigation, escalation, and death. While IMT training often reinforces investigation-driven practice, geriatric medicine foregrounds frailty, predictable illness trajectories, and anticipatory decision-making. Exposure to Universal Care Planning, Treatment Escalation Plans, and senior-led conversations about uncertainty legitimises non-intervention as an active clinical decision. Strengthening education around frailty, uncertainty, and death during IMT training may reduce non-beneficial investigation, improve patient-centred care, and help alleviate avoidable pressures on an increasingly constrained NHS.