Intensive Care Medicine training
The start of a journey
Dr CM Oliver, CT2 Anaesthetic trainee. Princess Alexandra Hospital NHS Trust.
Dr R Saha, Consultant Anaesthetist and Intensivist. Princess Alexandra Hospital NHS Trust.
Correspondence: rajnish.saha1@pah.nhs.uk
Introduction
The creation of the Faculty of Intensive Care Medicine (FICM) last year was
hailed as a “starting point …not a destination” [1]. However whilst it remains to
be seen whether the Faculty will evolve into a College of Intensive Care
Medicine, what is certain is that the foundation of the FICM signifies the
introduction of sweeping changes to the way individuals will train in Intensive
Care Medicine (ICM) in the UK.
The current structure of ICM training
Since 1999 it has only been possible to be awarded a Certificate of
Completion of Training (CCT) in ICM when jointly undertaken alongside
training in a parent specialty (Anaesthesia, Emergency Medicine, General
Internal Medicine or Acute Surgery). Despite Anaesthesia being the
commonest parent specialty historically, increasing numbers of medical
trainees are entering ICM training.
The competency-based joint CCT in ICM consists of: Training in ICM
 Training in the complementary acute specialties of Anaesthesia and/or
GIM such that all trainees have at least six months experience in each.
 Obtaining a CCT in one of the four primary specialties.
The minimum duration for CCT in ICM is five years once at ST3 which, in
addition to primary specialty training typically comprises six months of
dedicated ICM training (Step One) and a single block of twelve months ICM
training within the final two years of specialist training (Step Two).
The future of ICM training
The General and Specialist Medical Practice Order 2003 founded the Post
Medical Education Training Board (PMETB) [2]. The Order recognises ICM as
a single separate specialty requiring a single standalone CCT Programme.
This is to be implemented in August 2011.
The GMC has agreed that dual CCT training with a parent specialty will
remain acceptable, but with the creation of a standalone CCT it is likely that
dual accreditation will result in the temporal extension of training.
Entry to Higher Training
ICM trainees will enter ICM higher training through one of the three core
training routes; Acute Care Common Stem (ACCS), Core Anaesthetic
Training (CAT), or Core Medical Training (CMT).
Entry into higher training will occur at ST3 level by a competitive process and
will require successful completion of a relevant primary examination:




FFICM (Fellowship of the Faculty of Intensive Care Medicine) Part I
FRCA (Fellowship of the Royal College of Anaesthetists) Part I
MRCP (UK) (Membership of Royal College of Physicians)
MCEM (Membership of the College of Emergency Medicine) Part A
However once the FFICM examination becomes established it is likely to
become an essential requirement for entry into higher training.
Future CCT ICM Curriculum
A four part curriculum comprising a handbook, assessment system, syllabus
and competencies has been drafted by the FICM [3]. The competency based
curriculum is derived from the CoBaTrICE (Competency Based Training
programme in Intensive Care Medicine for Europe) syllabus of the European
Society of Intensive Care Medicine (ESICM).
During the seven year CCT programme trainees will progressively build a
portfolio of evidence to demonstrate that they have mastered ninety seven
competencies in the twelve following domains:
 Resuscitation and management of the acutely ill patient
 Diagnosis, Assessment, Investigation, Monitoring and Data
Interpretation
 Disease Management
 Therapeutic interventions/ Organ support in single or multiple organ
failure
 Practical procedures
 Peri-operative care
 Comfort and recovery
 End of life care
 Paediatric care
 Transport
 Patient safety and health systems management
 Professionalism
Competencies will be assessed using Work Place Based Assessment
(WPBA) tools and mapped to the four domains of good medical practice: Knowledge, skills and performance
 Safety and quality
 Communication, partnership and teamwork
 Maintaining trust
Assessment
The Annual Review of Competence Progression (ARCP) will be a formal
assessment of a trainee’s progress. The FICM is developing an e-Portfolio to
assist trainees to record their progress. Table 1 sets out the evidence a
trainee may need to provide at an ARCP for Stage One Training.
Log book procedures
A total of more than 15 to reflect choice of DOPS. Evidence of
progression/successful completion.
Log book cases
Unit Admission data allows yearly leaning outcomes to be fulfilled
Individual cases provide suitable case mix to achieve yearly learning
outcome.
Log book Airway skills
A total of more than 15 cases with evidence of progression of skill.
Exam
Possession of one of the designated core exams is needed for entry to
ST3.
Educational Supervisor report
Satisfactory report.
Audit
At least 1 audit completed during each stage of training.
Expanded Case
summaries
2 cases (at least Level 2 standard).
WPBA
At least 5 general ‘Top 30’ cases as CBDs, CEX or both. Up to 5
CoBaTrICE competencies can be covered in each assessment.
DOPS: chosen to reflect agreed CoBaTrICE competency assessments.
MSF: 1 per year.
Morbidity and
Mortality meetings
Journal clubs
Attend at least 4 and evidence of reflection from 1 meeting.
External meetings as
approved in Personal
Development Plan
Reflection on content.
Management
meetings
No mandatory requirement but attendance encouraged.
Present at least once.
Table 1 Assessments at ARCP
Examinations
Presently trainees have the option of sitting the UK Diploma in Intensive Care
Medicine (DICM) or the European Diploma in Intensive Care Medicine (EDIC),
the examination of the European Society of Intensive Care Medicine (ESICM).
Although these qualifications are not currently compulsory for attainment of
CCT in ICM, there has been an exponential rise in the number of candidates
sitting both examinations in recent years and job descriptions for consultant
appointments increasingly cite them as desirable or essential requirements.
An inevitable development in the evolution of ICM training is the creation of
examinations for trainees to become Fellows of the Faculty of Intensive Care
Medicine (FFICM). Becoming a FFICM will become a compulsory requirement
to obtain a CCT in ICM, effectively replacing the DICM and it is likely to impact
on the number of UK candidates sitting the EDIC.
The FFICM will be a two part examination with the Part 1 Primary examination
being developed during 2012 – 2014. This is expected to comprise a total of
ninety questions to be attempted over three hours. Forty questions will be in
multiple choice format and twenty-five questions each in single best answer
and extended answer formats. The examination will be taken at any stage of
training before ST3.
The Final examination will be taken after ST4 and is expected to comprise
three sections- MCQs, Objective Structured Clinical Examination (OSCE) and
Structured Oral Examination (SOE). The Final FFICM MCQ will follow the
format of the Primary FFICM exam and it will be possible to carry over a pass
in the MCQ component of the examination for three subsequent sittings of the
OSCE and SOE.
Conclusion
Despite its historical ties with anaesthesia, a successful training programme
affording non-anaesthetists improved access to ICM training has been
established. A cultural shift has now paved the way for a move to a separate
stand alone ICM CCT. Whilst the possible decrease in trainees with airway
skills is viewed by some as a route fraught with danger, it is hard to dispute
the benefits of a broadened skills mix in the multi-disciplinary environment of
the Intensive Care Unit.
That ICM should not remain a subspecialty is increasingly gaining support in
the UK and Europe and it remains to be seen if the foundation of the FICM
represents the starting point of a journey towards the creation of a College of
ICM. What is certain is that for trainees embarking on their ICM careers, it is
the start of an exciting and challenging journey.
References
[1] Bion J. News from the FICM. RCoA Bulletin 2011; 65; 15.
[2] The General and Specialist Medical Practice (Education, Training and
Qualifications) Order 2003.
[3] Curriculum for a CCT in Intensive Care Medicine. 3rd. Edition. The Faculty
of Intensive Care Medicine. 2011.