The current training programme for Intensive Care Medicine was launched in August 2012. The Thames Valley region typically appoints 6-8 trainees each year. Those trainees may train solely in Intensive Care Medicine, or may compete for appointment to a partner specialty in order to undertake dual specialty training. The partner specialties which have been approved by the GMC are general, renal, respiratory and emergency medicine, as well as anaesthesia. Appointment is co-ordinated nationally through the ICM National Recruitment Office .
When trainees are appointed, the Training Programme Director assesses their core and ST training to date and devises an individual training programme. Dual-specialty trainees have a combined programme devised by both Training Programme Directors working together which leads to the award of 2 CCTs. Training takes place at a number of approved sites across the region: Buckinghamshire Hospitals, Milton Keynes University Hospital, Oxford University Hospitals, the Royal Berkshire Hospital and Wexham Park Hospital. Placements are arranged in intensive care medicine (including sub-specialty areas), medicine and anaesthesia in line with the individual needs of trainees.
Competence is graded at 4 levels and trainees are expected to perform at higher levels as they progress through training. Trainees will therefore be exposed to the same case mix and workload at each stage of training, but will be required to demonstrate a higher level of competence in each stage. A brief outline of the competence levels is shown below, but more information is available on the assessment page of the FICM website.
|Level||Task orientated competence||Knowledge orientated competence||Patient management competence|
|1||Performs task under direct supervision.||Very limited knowledge; requires considerable guidance to solve a problem within the area.||Can take history, examine and arrange investigations for straight forward case (limited differential diagnosis). Can initiate emergency management and continue a management plan, recognising acute divergences from the plan. Will need help to deal with these.|
|2||Performs task in straightforward circumstances, requires help for more difficult situations. Understands indications and complications of task.||Sound basic knowledge; requires some guidance to solve a problem within the area. Will have knowledge of appropriate guidelines and protocols.||Can take history, examine and arrange investigations in a more complicated case. Can initiate emergency management. In a straightforward case, can plan management and manage any divergences in short term. Will need help with more complicated cases.|
|3||Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives.||Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically.||Can take history, examine and arrange investigations in a more complex case in a focused manner. Can initiate emergency management. In a most cases, can plan management and manage any divergences. May need specialist help for some cases.|
|4||Independent (consultant) practice.||Expert level of knowledge.||Specialist.|
Stage 1 training:
Trainees typically enter training at Stage 1, which encompasses core training and ST3/4. The Training Programme Director will construct a programme to ensure that by the end of Stage 1 all trainees have undertaken at least a year of ICM, a year of anaesthesia and a year of medicine. Examples of typical programmes are available on the FICM website for single and dual specialty programmes.
When trainees are placed in anaesthesia and medicine they often ask what they are supposed to aim for during their placement. There is a lot of information in the main curriculum handbook on the FICM website, which both trainees and their clinical supervisors can access. A summary of that information is available here in 2 documents: Anaesthetics for Stage 1 ICM trainees and ICM medicine flow diagram.
Stage 2 training:
By the time trainees enter Stage 2 training, they will all have completed at least a year of anaesthetics, a year of medicine and a year of ICM training. Stage 2 training consolidates this experience at a higher level and introduces specialty ICM in the form of cardiac, paediatric and neurointensive care. This specialty ICM training is undertaken in Oxford.
Single specialty trainees undertake a Special Skills Year during Stage 2 training and need to give some thought to this at least a year beforehand. Dual specialty trainees don’t do a separate special skills year because their other specialty is the special skill they bring to ICM.
Trainees can sit the final FFICM exam once they start Stage 2 training and must pass it before entering Stage 3 training.
Stage 3 training:
The final year of ICM training is undertaken in Oxford and the District General Hospitals across the Thames Valley. Typical placements are of 6 months duration.