The Diploma in Geriatric Medicine is awarded by the Royal College of Physicians in collaboration with the British Geriatrics Society. It recognises expertise in the healthcare of older people — and its relevance is growing rapidly as the NHS frailty agenda places geriatric competence at the centre of primary care, care home medicine, and community health services.
Since 2021, the DGM is open to all statutorily regulated healthcare professionals — doctors, nurses, AHPs, pharmacists, and physician associates. It is no longer a doctors-only credential, reflecting the multidisciplinary reality of elderly care delivery.
What the DGM Is and Why It Matters in 2026
The NHS frailty agenda has accelerated demand for clinicians with formal geriatric competence. ICB frailty programmes, care home enhanced services, and anticipatory care initiatives increasingly specify or prefer DGM holders. For GPs with care home or elderly care interest, the DGM provides a recognised, well-regarded qualification — and for non-medical professionals working with older people, it provides a structured credential that validates expertise.
Audience: GPs with care home or frailty interest, geriatric medicine trainees at CT level, care home physicians, community frailty clinicians, advanced practitioners in elderly care.
Exam Format
Part 1 — Knowledge-Based Assessment (KBA). 100 best-of-five (single best answer) questions. 3 hours. Online, remotely proctored. Held once per year. You must pass the KBA before sitting the clinical exam.
Part 2 — Clinical OSCE. Four stations, 15 minutes each (with 5 minutes reading time before each). Changed format from November 2024. The four stations are: Integrated Clinical Assessment 1, Comprehensive Geriatric Assessment (CGA), Ethical and Legal Principles in Practice, and Integrated Clinical Assessment 2. Held at the RCP Assessment Centre at The Spine, Liverpool. Twice yearly (June and November). Two examiners per station. Ten marksheets total. Nominal pass mark: 29/40.
Both parts must be passed. Four years from KBA pass to complete the clinical exam. Maximum 6 attempts per component. Open to all statutorily regulated healthcare practitioners with at least 2 years post-qualification experience and at least 4 months in a setting with high elderly patient contact.
Syllabus — Key Domains
Comprehensive Geriatric Assessment (CGA)
The CGA framework is the organising principle of geriatric medicine. Domains: medical (problem list, active diagnoses, medication review), functional (ADLs — Barthel Index; IADLs), cognitive (4AT for delirium screening, MoCA/AMTS for cognitive assessment), psychological (GDS — Geriatric Depression Scale), social (living situation, carer burden, community services), and nutritional (MUST screening). Multidisciplinary team roles for each domain.
Frailty and Falls
Frailty identification: Clinical Frailty Scale, electronic Frailty Index (eFI), Fried phenotype criteria. Falls assessment: NICE NG161, multifactorial intervention (strength and balance exercise, medication review, home hazard assessment, postural hypotension management, vision correction). Bone health: FRAX, DXA, bisphosphonates, calcium/vitamin D. Hip fracture management pathway.
Dementia and Cognitive Impairment
NICE NG97. Subtypes: Alzheimer's, vascular, Lewy body, frontotemporal — differentiating features. Assessment tools: MoCA, ACE-III, 4AT. Pharmacological management: cholinesterase inhibitors, memantine. BPSD: non-pharmacological approaches first. Mental Capacity Act in dementia care. Advance care planning.
Delirium
The "3 Ds" differential: delirium vs dementia vs depression. 4AT screening tool. NICE CG103. Prevention. Non-pharmacological management. When antipsychotics are appropriate. Hypoactive delirium (commonly missed).
Polypharmacy and Prescribing in Older Adults
STOPP criteria (potentially inappropriate medications). START criteria (medications that should be started). Deprescribing approach. Renal impairment dose adjustments. Anticholinergic burden (ACB score). Common adverse drug reactions in elderly (falls from sedatives/antihypertensives, AKI from NSAID/ACEi/diuretic combination).
End-of-Life Care
NICE NG142. Advance care planning. ADRT (Advance Decision to Refuse Treatment). ReSPECT process. DNAR/DNACPR discussions — legal and ethical framework. Symptom management in the last days of life (pain, nausea, secretions, agitation). Anticipatory prescribing.
Common Geriatric Syndromes
Incontinence (urinary and faecal), pressure ulcers (prevention and classification), malnutrition (MUST tool), dysphagia assessment, constipation management. NICE guidance for each.
Stroke and Rehabilitation
NICE NG128. Thrombolysis criteria. Thrombectomy. Early stroke unit admission. Secondary prevention. Rehabilitation principles, goal setting, and intermediate care.
Best DGM Revision Resources in 2026
iatroX DGM Adaptive Q-Bank
iatroX Boards provides 400+ adaptive questions mapped to the DGM syllabus — one of the very few dedicated DGM revision resources. Most geriatric medicine MCQ content is buried within MRCP banks and is not specifically mapped to the DGM curriculum.
Performance dashboard by domain: frailty, dementia, delirium, polypharmacy, end-of-life, falls, CGA. NICE integration: NG97 (dementia), NG161 (falls), NG142 (end-of-life), NG128 (stroke), CG103 (delirium). A single subscription includes the DGM bank alongside other specialty Q-banks. MHRA-registered platform.
BGS Educational Resources
Case-based learning and guideline summaries from the British Geriatrics Society. Free. Useful as background reading.
NICE Guidelines Directly
NG97, NG161, NG142, NG128, CG103, NG56 (multimorbidity), NG5 (medicines optimisation) — core reading. iatroX explanations link to these; supplement with direct reading of key recommendation sections.
Oxford Handbook of Geriatric Medicine
The most practical clinical reference. Covers all major geriatric conditions concisely.
10-Week Revision Plan
Weeks 1-2: iatroX baseline + CGA framework and frailty scoring. Weeks 3-4: Dementia and delirium (densely examined). Week 5: Polypharmacy, STOPP/START, prescribing principles. Week 6: Falls and bone health (NICE NG161, FRAX, hip fracture). Week 7: End-of-life, capacity, advance planning, ReSPECT. Week 8: Geriatric syndromes (incontinence, pressure ulcers, nutrition). Week 9: Stroke, rehabilitation, secondary prevention. Week 10: Mixed adaptive sessions + clinical OSCE preparation.
Clinical OSCE Preparation
The delirium-dementia-depression differential practically always appears in some form. Practise CGA systematically with real patients. Practise capacity assessment conversations (Mental Capacity Act five principles, two-stage test). Practise end-of-life discussions (ceiling of treatment, advance care planning). The examiners want a systematic CGA approach and the ability to formulate a multidisciplinary management plan.
Start at iatroX Boards — 400+ adaptive DGM questions mapped to the full syllabus.