From August 2012 Oxford will offer a stand alone CCT programme in Intensive Care Medicine. The training is a five year programme, starting at ST3.
The expected rotation arrangements for this programme are:
ST3 12 months in the two Adult Intensive Care Units in the teaching hospital (Oxford University Hospitals Trust).
ST4 12 months in acute medicine/anaesthesia training as required. It is likely that this will be in one of the district general hospitals in view of the case mix and clinical support experience available.
ST5 3 months each in regional specialist ICUs (Neurosciences, Cardio-thoracic and Paediatric ICU at the John Radcliffe Hospital); 3 months in another general ICU within the region.
ST6 12 months ICM with special skill training. The likely available options would be echocardiography training or simulation / medical education training. Please see below for further details.
ST7 12 months advanced ICM training in the Adult Intensive Care Units (Oxford University Hospitals Trust), with up to 6 months in another General Adult ICU in the region.
Rotations may at times change in response to clinical need from the Trusts and training requirements.
The Oxford region has a strong tradition of training excellent which was reflected in the 2011 GMC training survey ranking of the program as the highest in the country for overall satisfaction. All joint CCT trainees have secured consultant post in ICM at the end of their training and the DICM pass rate is over 95%. The training environment is continually monitored using the PHEEM questionnaire and all training centres offer active teaching programs and host regional meetings.
The programme offers an outstanding range of training opportunities. In addition to attachments to standard specialist units the region has a tradition of offering extra short attachments to related specialities. Popular attachments have included microbiology, radiology and hepato-biliary ICM and there is currently a fully funded travel bursary to Hong Kong awarded yearly to an Intensive Care trainee in the region.
The ST6 year represents a particularly interesting opportunity for the ICM trainee to develop expertise in an area related to Intensive Care. At this early stage of curriculum development the intention is to adapt 2 existing and successful ICM posts in the region that currently offer Echocardiography and Simulation training.
The echocardiography training post combines ICM-specific trans-thoracic echocardiography with further advanced ICM experience. The post provides comprehensive training from both ICM and cardiology trainers, taking the novice up to British Society of Echocardiography standard. The successful program has run for several years and a report was published recently (JICS 11:1 2010). The fellowship represents an opportunity to develop a sought-after clinical skill with applications in any ICU.
The medical education post offers a subsidiary interest in Simulation training. The training rota includes protected time for work with OxStar, the state of the art “Simulation Centre” based at the John Radcliffe Hospital. The successful candidate develops expertise in simulation, leads simulation training on the Intensive Care units, undertakes a higher level formal teaching qualification and can take up research opportunities as offered by the OxStar centre. The post has the potential to provide a thorough grounding for a trainee with an interest in teaching and training.
Training Centre Information
Adult Intensive Care Unit (AICU) and Churchill Intensive Care Unit (CICU)
These two general Intensive Care Units admit over 1000 patients per year. The majority of patients are level 3. Approximately 20% of admissions are elective surgical patients and the remainder critically ill emergency patients with a wide range of medical and surgical pathologies. Oxford is the tertiary referral centre for major trauma, spinal, interventional cardiology, oesophageal, vascular, major maxillo-facial surgery, interventional radiology, haematological malignancy and transplantation (including bowel and pancreas). This is reflected in the pathology of patients on the AICU/CICU. The Standardised Mortality Ratio is significantly below the national average.
A full range of invasive monitoring and all major forms of organ support are employed. The majority of patients require multi-organ support and invasive monitoring. Trainees can expect to gain experience of oesophageal Doppler monitoring, thrombo-elastography, renal replacement techniques, echocardiography, bronchoscopy, ultrasound, invasive and non-invasive ventilation as well as more basic procedures such as line placement and resuscitation.
The units are medically staffed in multiple groups: three groups of trainees (from both an anaesthetic and non-anaesthetic background) and the consultant tier. The presence of trainees from a variety of backgrounds provides a fantastic training environment and so represents a rare opportunity given the UK system of early specialisation. It is particularly useful for those trainees doing professional exams and helps our high success rate in the FRCA final/DICM and EDIC.
The twelve consultants cover each unit separately on a split week system. The consultants come from a background in anaesthesia, medicine, military services and research. There is local expertise in clinical trials research, bench research, sepsis and genomics, ventilation, difficult airways, teacher training, simulation, international transfer, primary trauma in developing countries, resuscitation, follow up, ultrasound and echocardiography.
The unit has an active teaching programme. This includes protected teaching, weekly unit meetings, daily microbiology rounds and various yearly meetings. The senior trainees have an active exam orientated program in addition to one half-day per month of protected teaching. This contributes to the high success rate in the Diploma.
The Neurosciences Intensive Care Unit
The Oxford Neuroscience Unit is one of the busiest regional neurosurgical units in the country with an international reputation for the quality of its services. It is involved in many aspects of pioneering work including functional neurosurgery and radiological interventional techniques. The busy unit will provide trainees with unrivalled exposure to all aspects of neurosurgical work. The Oxford Neurosciences Unit moved to a new purpose-built modern facility in the West Wing of the John Radcliffe Hospital in January 2007.
The Neurosciences Intensive Care Unit provides level 2 and level 3 specialist critical care to both neurosurgical and neurological patients from the region. The Unit currently contains 11 level 3 critical care beds, with planned expansion over the next few years to a 17 bed unit. Training is provided in the management of the full range of neurosurgical and neurological pathologies, with particular emphasis on the management of traumatic brain injury and subarachnoid haemorrhage.
Cardiothoracic Critical Care Unit
The John Radcliffe Hospital is a tertiary referral centre for cardiac and thoracic disease. The Cardiothoracic Critical Care (CTCC) is an 11 bedded unit supporting an annual caseload of approximately 950 adult cardiac cases of which 65% represent patients undergoing coronary bypass grafting, 20% valve repair or replacement and 15% combined or complex procedures. About 100-200 thoracic cases are performed each year. Consultants lead twice daily ward rounds of the Cardiothoracic Critical Care (CTCC), and supervise the postoperative intensive care of adult patients undergoing heart and thoracic surgery. There is local expertise and training in trans-oesophageal echocardiography.
The Paediatric Intensive Care Unit
The tertiary Paediatric Intensive care Unit serves the Oxfordshire population and supports a wide range of both surgical and medical paediatric specialties in all the Oxford hospitals. Elective surgical specialties include general and urological surgery, orthopaedics, craniofacial, plastics, neurosurgery, ENT, dental and ophthalmology whilst the medical specialities include oncology, radiology (including MRI), radiotherapy, gastroenterology and cardiology.
This ICU has 11 beds for mainly level 3 patients. The 8 consultants work a weekly rota incorporating a second consultant for extra supervision and teaching. The 7 trainees work a full time rota with provision of extra clinical experience in other departments such as echocardiography, microbiology and bronchoscopy. The weekly consultant led teaching and radiology sessions are particularly well evaluated. The unit has a progressive approach to educational supervision.
In addition to standard pathologies, patients are treated after major urological, vascular and oesophageal surgery and spinal trauma. Level two paediatric patients are also supported.
Trainees can expect exposure to a variety of advanced monitoring and therapeutic procedures. Examples include percutaneous tracheostomy (100 per year), ultrasound, ODM, echocardiography, bronchoscopy, PICCO and intracranial pressure monitoring (inserted by the ICU staff). Audit and research are encouraged and supported by a powerful clinical information system, research nurses and a data manager. The research team are the leading recruiters to many national trials.
Reading also has expertise beyond the traditional boundaries of Intensive Care. The follow-up clinic is the second oldest in the UK and there is a 24/7 outreach service. A centrally funded bereavement expert co-ordinates relative follow-up, organ donation and staff pastoral care.
These 2 expanding ICUs have 16-20 beds with input from 15 consultants. In addition to the usual DGH specialties, the unit is the regional centre for acute spinal injury and major burns. This provides exposure to these highly specialised areas of the Intensive Care syllabus including free flap reconstructive surgery, weaning and rehabilitation of acute spinal injury and burns patients. In addition to routine procedures, percutaneous tracheostomy and Doppler flow monitoring are performed on the ICU.
This unit has recently been rebuilt into a state of the art general ICU with 12 level 2 and level 3 beds. Nine consultants contribute to dedicated 24 hour cover and lead three ward rounds per day. The midday round is actively supported by specialist pathology / microbiology, pharmacy, clinical biochemistry and respective surgical specialties. There is a very busy outreach service which provides trainees an insight into flagging up potential ICU admissions and their management in the wards. An ICU follow up clinic is well established. Research & audit is greatly encouraged and actively taken up by most trainees. A weekly formal teaching programme is conducted within the department and all trainees have a protected half day for this activity.
Practical procedures training is provided in routine ICU procedures such as lines, haemofiltration etc. Specialist procedures include percutaneous tracheostomy (about 50/yr), intra-cranial pressure transducer placement & monitoring, oesophageal Doppler and PiCCO cardiac output monitoring.
This unit runs flexibly up to a maximum of nine level 2/3 patients. There is dedicated daytime consultant sessional commitment.
Specialist procedures performed routinely on the unit include percutaneous tracheostomy (about 50/yr), intra-cranial pressure transducer placement & monitoring, oesophageal Doppler cardiac output monitoring, Bi-Spectral Index monitoring and fibre-optic guided airway training.