Intensive Care Medicine

Training In Intensive Care Medicine

In January 2011 the GMC recognised Intensive Care Medicine as a stand alone specialty and the Faculty of Intensive Care Medicine (FICM) formed. From August 2012 the new ICM training programmes will start. Previously (appointments will continue to be made up to 31st July 2013) Training in Intensive Care Medicine (ICM) was undertaken alongside a primary specialty of Anaesthesia, Medicine, Emergency Medicine or Surgery. All training is competency based as set out by the FICM.

NEW ICM TRAINING STRUCTURE

Entry to the programme is via competitive interview and requires core training in ACCS [Acute Common Stem] or CAT [Core Anaesthetic Training] or CMT [Core Medical Training]. Examinations required – FFICM Primary or FRCA Primary or MRCP (UK) or MCEM Parts A, B and C.

The training programme is structured as shown below.

Training Stage

Training years

Description

Stage 1

CT1-2

This is when core competencies are obtained. 1 year of medicine and 1 year of Anaesthesia are also completed.

ST3-4

Stage 2

ST5-6

This is when specialist skills are developed and specialised areas of ICM are covered (cardiac, neuro and paeds)

Stage 3

ST7

This is a finishing year when independent practise is established

This can be completed as a single CCT or after 2013 trainees with a NTN in ICM can apply for another specialty NTN (e.g. renal, anaesthesia, acute medicine, respiratory or Emergency Medicine), which will enable them to achieve a dual CCT in ICM and their other specialty - http://www.ficm.ac.uk/icm-cct-curriculum/dual-ccts

ASSESSMENTS FOR DUAL CCT PROGRAMME (“The new programme”)

 

ICM training prior to the formation of the FICM programme – August 2012

ICM training was divided into BASIC, INTERMEDIATE and ADVANCED. Information about these is listed.

Basic

This can no longer be undertaken. Previously it consisted of 6 months medicine, 6 months of Anaesthetics and 3 months of ICM in a recognised teaching unit.

Intermediate

This will probably stop in about 2 years time. Intermediate training normally lasts 6 months and is taken in one or two blocks. Again this can take place in any unit with training accreditation, but at least 3 months tends to occur in the Oxford Adult Intensive Care Unit. During this period of training trainees complete 10 extended case histories which are assessed by their educational supervisor in the first instance and then assessed and signed off by the regional advisor in ICM.

Complimentary Specialist training

This is part of Basic training. All trainees must complete a period of training in both anaesthesia and medicine. Opportunities exist within the region for novice anaesthesia trainees to get medical experience and vice versa as part of the Acute Care Common Stem program.

CCT Program and Advanced Training

The Oxford region runs a successful joint CCT program in Intensive Care. At the time of writing there are six numbered posts in the region that lead to a dual CCT of ICM and the trainee's primary specialty. Candidates apply in ST3-5 (SpR1-3) of their primary specialty for this popular training scheme, which consists of 12-18 months out of programme advanced training, finishing within a year of their primary training completion date. Advanced trainees are encouraged to sit the UK DICM and have an extremely high success rate.

This more advanced training is based in Oxford with some posts rotating to The Royal Berkshire Intensive Care Unit. Modules of specialised ICM are available in microbiology, radiology, Cardiothoracic, Neurological and Paediatric Intensive Care. In addition to comprehensive critical care training, the successful candidates have opportunities to develop experience in management, research, teaching and audit. They are encouraged to lead ward rounds with appropriate supervision and take a lead role in the organization of medical staff. There is even an opportunity to travel to Hong Kong on a fully funded travel bursary (Kadoorie Prizes).

In addition to this scheme there are potential opportunities for anaesthesia trainees to gain Advanced Training Recognition in ICM outside the CCT program, by rotating through the AICU as part of Additional Study Modules.

The Joint CCT and Advanced training Recognition programs are recruiting until August 2013 as per national guidance. After this time the only route for advanced ICM training will be via the CCT program (please see separate section).

FTSTA posts in Intensive Care

There are currently 2 FTSTA posts in the region (one at Oxford Radcliffe Hospitals Trust and one at Royal Berkshire NHS Foundation trust). The objective of these posts is to provide a thorough grounding in ICM. They are suitable both for trainees who subsequently might wish to practice the specialty and those who expect to practice hospital medicine in an acute specialty in which there is currently no provision for training in ICM, but for which training in ICM is of value. Examples include but are not limited to emergency, acute medicine, cardiology, chest medicine, cardiothoracic surgery and nephrology.

The scheme provides training in the care of the critically ill patient as per guidelines set out by the FICM. The posts last 6-12 months and aim to incorporate Basic and Intermediate training dependant on length of appointment. There is potential to include complimentary specialty training within the scheme for exceptional candidates who are planning a future career in ICM. They are suitable for trainees who have done no formal ICM or have up to one years training in the specialty.

ASSESSMENTS FOR JOINT CCT PROGRAMME (“The old programme”) 


ICM Teaching

Intensive Care CT1/2 study days

The BASIC course is run in September for those trainees starting in ICM and is based in Reading. In addition there are CT1/2 study days exclusively for CT1/2 and run twice a year at Wexham Park Hospital. Basic Intensive Care issues are approached through a combination of small group sessions and lectures from regional experts. The use of innovative teaching techniques attracts large numbers and formal feedback continues to be excellent.

Transfer training days

Thames Valley Critical Care Network delivers training in the transfer of the critically ill patient to all critical care trainees in the region. This multi-disciplinary centrally funded one day course was developed in the region and now runs several times a year. Candidates are not only trained to facilitate safe transfer, but also to consider the clinical and strategic aspects, informed by National guidelines and the Network organisation.

ALERT training

ALERT stands for Acute Life-threatening Illness Recognition and Training. This multi-disciplinary one day course runs several times a year in various hospitals in the region. Over 2000 candidates have now been taught the basic skills needed to look after the critically ill patient outside the ICU. The course uses innovative teaching techniques such as role play and high-fidelity simulators. The course therefore provides an ideal setting for critical care trainees to develop their own teaching skills with the support of experienced educationists and experts in the area.

Kadoorie Critical Care and Trauma Training and Research Centre

This purpose built training and research centre is at The John Radcliffe Hospital in Oxford. The teaching facilities include state-of-the art audio-visual equipment and a high-fidelity simulator in a realistic clinical environment. The active research group focuses on critical care and trauma, and is responsible for co-ordination of both local and national trials. Integral to this professional set up is the co-option of critical care trainees into research projects. This provides a fantastic opportunity for senior critical care and anaesthesia trainees to get involved in high quality research during their clinical training.

Kadoorie Training Prizes

Each year a critical care trainee within the Oxford region is awarded a fully funded travel bursary to visit The Prince of Wales Hospital Intensive Care Unit in Hong Kong. The award is made on the basis of a proven track record of commitment to ICM training, the 10 case histories and dissertation prepared for the diploma exam. As far as we are aware Oxford is the only region in the country to offer such an award to a critical care trainee and so represents a fantastic opportunity.

Please see the prizes section for further details of previous winners. 


The Intensive Care Medicine Training Programme