Trainee Journeys

ICM Trainees work across the entire spectrum of medical and surgical pathology providing a varied and robust working environment.

Below are accounts of the rewarding and exciting path ICM Trainees have taken.

Trainee Journeys

Back in 2014 the Faculty invited ICM trainees from different specialties and regions to tell us why they had decided to undertake ICM as part of their training and what it’s like to be an ICM doctor.

We have been in contact with the very same trainees to get an update on their training progression to date, read on to see how they are getting on…

I am currently in the final few months of a 3 year OOPR studying the use of Mesenchymal 
Stem Cells (MSC) in Models of liver injury. My OOPR will hopefully lead to a PhD and has 
been funded by a competitively awarded MRC clinical research training fellowship. When I 
return to clinical training I will be an ST4/5 in the dual training programme with intensive 
care medicine (ICM) and anaesthetics. 

I studied undergraduate medicine at the University of Birmingham as a second degree, 
having completed a degree in Computer Science at the University of Manchester prior to 
this. I decided to stay in the West Midlands for my Foundation training and have always 
been interested in anaesthetics and ICM as well as research. I did not pursue the academic foundation pathway as I was keen to gain as much clinical experience as possible in my early training years. I did however continue to pursue research interests in my own time studying resuscitation and gaining multiple publications. 

I applied for the Acute Care Common Stem (ACCS) with anaesthesia as a base specialty at ST 1 as I was keen to gain further acute care experience. I again did not pursue an academic posting as there were none available in the West Midlands at that time for my intended specialty. At ST3 I secured an Academic Clinical Fellowship (ACF) on the Single CCT ICM training programme allowing me 25% research time and 75% clinical time. After a year I also applied for an anaesthetic ST3 number and entered into a dual programme, allowing me to keep my academic time with some negotiation. 

During my ACF I spent my clinical time at the Queen Elizabeth Hospital in Birmingham 
(QEHB) working towards my intermediate anaesthetics competencies and stage 1 ICM. My 
academic time was split between assisting with a clinical trial studying the effects of 
suppression of cytomegalovirus reactivation in critical care, now published (Cowley, Owen 
et al JAMA Internal Medicine, 2017) and undertaking basic science research into MSC 
biology. I subsequently went on secure an MRC funded CRTF and left my ACF to undertake 
this as an OOPR after 2 years. Prior to leaving my ACF I completed the MRes programme and submitted a thesis based on my MSC work. 

During my CRTF I have been working towards a PhD. I have undertaken basic science 
research and learned a lot of new and useful laboratory techniques. I have also taken the 
opportunity to advance my teaching and leadership experience by taking on a role at the 
university as the lead for procedural skills on the MBChB course and being selected through competitive application as a trainee representative on the National Institute of Academic Anaesthesia (NIAA) board. This has also led to being co-opted to the trainee council as an academic representative. In order to maintain my clinical skills during my 3 year OOR I have an honorary contract at QEHB and have worked in ICM and liver anaesthesia. I have also taken the opportunity to undertake more pre-hospital care, completing my blue light driving license and taking out an ambulance service vehicle for the West Midlands CARE Team responding to trauma and medical incidents. 

When I return to programme I aim to continue with my training as a Clinical Lecturer which 
would give me more protected research time, and at completion of training I am aiming 
towards a clinician scientist award to enable me to split my time as a consultant between 
academia and clinical practice where I hope to be a dual qualified anaesthetist and 
intensivist with a special interest in liver disease.

Current training

  • ST6 dual training in Anaesthesia & Intensive Care Medicine (ICM) in Severn Deanery
  • Completed subspecialty Pre-Hospital Emergency Medicine (PHEM) training in August 2015 I became interested in anaesthesia and the critically ill patient whilst at medical school in London, when I wasfortunate enough to have time in anaesthetics and intensive care, along with an elective in emergency medicine and pre-hospital care.


I moved to the Oxford Deanery for Foundation Programme and chose a rotation that included anaesthesia and intensive care as an FY1 and emergency medicine as an FY2. I applied for ACCS anaesthesia for core training. My reasons were that it would give me more acute medicine and emergency medicine experience, useful for both ICM and Pre-Hospital Care and, in doing so, broaden my experience for the future.

I moved to the Severn Deanery in order to start ACCS and have stayed here ever since, gaining an ST3 training number in anaesthesia in 2012 and subsequently an ICM number for dual accreditation in 2013. In 2012, Pre-Hospital Emergency Medicine (PHEM) was approved by the GMC as a subspecialty of anaesthesia, acute medicine, emergency medicine and intensive care medicine. The first national recruitment was held in late 2013 for commencement in August 2014. I was one of the first 20 trainees nationally to undertake PHEM subspecialty training.

PHEM subspecialty training was developed to formalise the training that doctors were receiving on an ad-hocbasis from air ambulances and critical care teams around the country. It is a GMC recognised subspecialty with a very detailed curriculum, workplace-based assessments and two examinations (Diploma in Immediate Medical Care and Fellowship in Immediate Medical Care). I undertook my PHEM training with Great Western Air Ambulance in Bristol. Completing it has added 12 months to my training and, at the time of writing, I am the only trainee in the country who has undertaken dual anaesthesia and ICM training and also PHEM subspecialty training.

I chose this combination of programmes as it exposes me to some of the sickest patients and most challenging situations and environments. I enjoy the unpredictability and challenges presented by intensive care and pre-hospital care, and the skills and challenges presented by theatre cases in anaesthesia.

Following PHEM training, I have continued with my anaesthesia and ICM dual training in Severn. Day-to-day, my work is defined by which rotation I am doing – anaesthesia puts me in theatre with largely elective patients during the daylight hours and emergencies outside that time, whereas intensive care is much more unpredictable. In addition, I have the support of my School of Anaesthesia to continue my PHEM exposure by working as a critical care doctor with Great Western Air Ambulance. My days doing this are completely unpredictable, with adult and paediatric patients, major trauma, medical emergencies and cardiac arrests. It is this variety, the team working, leadership, and satisfaction of delivering the best possible care to patients in all environments that I enjoy most.

As the final year of my training approaches, I am about to embark upon my Stage III ICM training and am looking ahead to CCT and consultant jobs. When I wrote the first version of this biography in 2013, there were very few formalised job plans that included pre-hospital care for consultants. Things have changed significantly in the past four years and there are an increasing number of consultants, including a significant proportion of trainees who have CCT’d with PHEM subspecialty training, who have a formal job plan that includes both their in-hospital and pre-hospital work. It is my aspiration to continue to combine my interests in anaesthesia, intensive care medicine and PHEM in my future career as a consultant.

Scott Grier, June 2017

For more information about Pre-Hospital Emergency Medicine subspecialty training, visit www.ibtphem.org.uk where you can find information about your local Training Programme Director. I strongly recommend you speak to them, and your parent specialty TPD, early if you are considering doing PHEM. The PHEM Trainees’ Association (PHEMTA) represents current and completed PHEM trainees and is able to signpost helpful sources of information for those considering the subspecialty – visit https://fphc.rcsed.ac.uk/phemt

I have wanted to do anaesthesia and intensive care since my 4th year at medical school. I organised several attachments in paediatric anaesthesia and in ICU during my F1 and F2 years. I initially planned to go to Australia for a year between F2 and core training, but this unfortunately fell through so I applied for a trust grade post in Acute Medicine and A&E, which proved to be an invaluable learning experience. During my first three years after qualifying I also volunteered at a race track and became interested in prehospital medicine, and I took the MRCP part 1. I moved to London to do my ACCS core training, and chose to stay here for my registrar jobs. During my core training I completed the MRCP in addition to the Primary FRCA. If I am honest, applying for my number in ICM was a little last minute. I had essentially decided during my core training that I would only apply for an anaesthetic number for various reasons. However, one of my ICU consultants told me he thought it would be a crime if I didn’t do ICM... So I applied, and I am so happy that I did - I love it!

The training programme in the North Central School of Anaesthesia is incredible - there are some amazing opportunities to work in hospitals with world leaders in their fields. The programme directors are approachable, helpful and have gone out of their way to allow me to tailor my anaesthetic training to enable me to obtain both my higher anaesthesia and ICM competences without having to do any further placements. They are extremely flexible and liaise regularly with the programme directors for ICM, and as such I have been fortunate enough to organise an amazing rotation.

I am due to gain my dual CCT in February of next year, and I hope to apply for a consultant post with a 50:50 mix between the specialities. I am interested in high-risk and big case anaesthesia, perioperative and emergency trauma medicine, and organ donation: these are all areas that have peaked my interest during experiences I have had during my training rotation. I hope to start volunteering in third world countries after I CCT.

I am a ST7 Emergency (EM) and Intensive Care Medicine (ICM) trainee from Mersey Region, Health Education North West.

During my ED rotation, I spent most of my time in the Resuscitation Room and enjoyed looking after acutely unwell patients across a wide range of different specialties. I embrace the idea of being a ‘Jack of all trades’ doctor who is able to provide comprehensive care to patients. After completing foundation year programme, I enrolled into the ACCS Emergency Medicine training with a primary intention to be an Emergency Physician.

During my ACCS rotation, I had the privilege to work in one of the busiest ICU in the Mersey Region. Through this I discovered that ICU in many ways resembles ED where both departments look after a cohort of undifferentiated patients. Through my observation, Specialty clinicians from both fields are able to attain quick diagnostics, confirm diagnosis and treat rapidly based on quick turn-around of information. This has therefore inspired me to consider ICM as a lifelong career.

After seeking advice from several Intensive Care consultants, I come to realise that there is a possibility of combining training from both specialties. With my completion of 3 years ACCS training and MCEM, I was eligible to apply for this very first ICM training scheme. In 2013, I successfully obtained EM higher training post in the same region which enabled me to become one of the first Dual CCT trainees.

In ED, critically ill patients constitute a significant proportion of the resuscitation room where majority of the patients require complex medical treatment and critical care input including ICU or HDU. Due to the shortage of higher level care beds, it is not uncommon to witness advance medical treatment being initiated in ED department i.e. central vascular access for cardiovascular support, NIV support etc. Being trained in both specialties has given me valuable skills to manage such complex medical patients. With further airway and anaesthetics skills which I have acquired from intensive care training, I am more comfortable in dealing with airway emergencies and performing both interhospital and intrahospital transfer of sick patients. Undoubtedly my communication with family members has also improved significantly when breaking bad news in ED.

In ICU, I have had to use a good amount of urgent care skills. I manage to integrate my EM skills to improve patient’s care with my resuscitation skills and broad clinical experiences. In addition, I can also utilise my procedural skills in ICU setting for instance, inserting surgical chest drain, closing ICP bolt wound with sutures, reviewing facial x-ray on a maxillofacial trauma patient, examining patient’s eyes for abrasion or removing foreign body etc. I was once even asked to perform a head injury assessment on a patient who fell off from his bed on the unit!

I enjoy teaching and sharing experiences with my colleagues. I am an instructor for ALS and APLS and was recommended to be an Instructor for other courses e.g. ATLS and MOET. I have also obtained the Post-Graduate Certificate in Medical Education during my ST3 to improve my teaching skills. Locally, I helped co-ordinate the Regional ICM teaching. In addition, I also represented EM higher trainees in the STEC meeting to improve the local training programme. I have also developed great interest in point of care ultrasound (POCUS) in assessing critically ill patients. During my dual CCT training, I’ve managed to achieve accreditation in FICE and CUSIC programme. I am now a mentor for both of these programmes.

In future I believe the job prospect is promising as both of these specialties are relatively young and rapidly expanding. The presence of an emergency/intensive care physician in the department is likely to benefit not only the patients but also the department itself. Committing to both specialties also ensure that my clinical skills and knowledge are kept up to date. I am also confident that this new ‘hybrid’ of dual specialty physician will be in high demand, especially in those major teaching hospitals and trauma centres. I strongly encourage Emergency Medicine trainees to consider this attractive Dual CCT role in order to enrich your clinical experience.

Leo Khoo

ST7 Emergency Medicine and Intensive Care Medicine

Mersey Deanery

My Stage 2 training will come to an end in August 2017; it’s been a busy two year period. Things haven’t worked out as planned but they worked out well nevertheless.

My plans of an out of programme training experience in Canada failed due to logistic reasons (not related to the training programme I must say); instead I stayed here in Manchester. I’ve completed my specialist skill year which happened to be in respiratory, cardiology and care of the elderly medicine and I’m now training in my ICU specialties: NICU, PICU & CICU.

All exams are a success, both FFICM and Acute Medicine SCE, which is a big relief. A word of advice; get them done early and clear the way to develop your skills on how to become a consultant. Soon after the exams, I completed the leadership in practice course, which was a very useful exercise. I also had the chance during my respiratory job to get level 1 Chest USS accreditation. It wasn’t easy but when there’s a will there’s a way. I’m now working on my FICE accreditation, and might consider CUSIC.

I have passed through different countries & different training programs throughout my training so far. I graduated from University of Baghdad, Iraq, times were difficult back home, and I had to spend a good part of my senior year in Kurdistan which meant I had to learn Kurdish! Following graduation I relocated with my family to Dubai, UAE, and underwent a year of internship there which is basically an FY1 job in UK training terms.

Life took me to Beirut – Lebanon and I joined the American University of Beirut Medical Center Internal Medicine Residency Training Program for three years, and that’s where I started to become interested in Intensive Care and acutely unwell patients. The training program there follows an American style whereby Critical Care is coupled with Pulmonary Medicine, that was the bit that didn’t intrigue me much.

I decided to tackle the MRCP. Exams were a success and the GMC registration soon followed. I applied for my Intensive Care number in 2012 when it first became a standalone specialty, as soon as I joined the training I knew that this is what I want to do day in day out but maybe add in a bit more Medicine. I applied for my Acute Medical number the following round in 2013 and now I’m on the dual training track for both ICM & AIM.

I started my Intensive Care registrar job in Anaesthesia, which as a medic it did seem an out of body experience at first but I soon caught up and got used to it. I enjoyed learning the practical skills and developing my situational awareness. A year of general Intensive Care came afterwards and then I was handed over to Acute Medicine to complete my stage one training.

I consider myself lucky to be able to train in both ICM & AIM as it allows me to experience a spectrum of illness from the stable but chronically ill to the extremely unstable acutely ill patient. I like to be kept on my toes yet have some less intense time at work and this combination does it for me.

Being passionate about saving lives, I volunteer to teach BLS with the British Red Cross, I do try to keep regular sessions teaching in the community – rota permitting of course. I’m also faculty for the IMPACT course teaching acute illness and practical producers. A big part of both jobs is communication with patients, families and colleagues; it’s a skill that I’ll continue to learn 2 throughout my career. The best way to learn, they say, is to teach and so I started last year to tutor communications skills to medical students. I have always found teaching an enjoyable domain.

I feel privileged to be training in the North West; directors, advisors, tutors and trainers are all accommodating, approachable and really try to make your life easy.

Finally, I really think the combination works. ICM & AIM complement one another and provide a good balance in the nature of clinical encounters that one would come across. A patient’s journey may well start on MAU carry on to ICU and then back to the community.

So put your applications in and join the ranks of dual trainees, there is plenty to choose from and certainly plenty to do with your careers.

I have been asked to provide an update on my ‘career story’ for the FICM website. This account will have a slightly different tone to that of the blindly optimistic account I provided as an ST3 registrar, not least because my colleagues have mocked me for my excessive use of stomach-turning clichés.

I am now less than two years from the end of my dual ICM/Anaesthesia training in South Yorkshire. As a registrar there have been a lot of highs and a few lows.

The most significant highs have come from the feeling that I am regularly playing my part in a team that provides high quality care to critically ill patients and their families. It is the pleasure that I derive from the clinical work that has motivated me to persevere with dual training at the times when it has been difficult.

Beyond bedside medicine, the skills developed as an Intensive care trainee lend themselves to service development and medical education. I have enjoyed being able to initiate and manage multiple projects to the point of introducing new departmental protocols and deliver teaching in a range of formats.

The standout low point for me was dealing with the consequences of my failure to manage my ePortfolio during stage 1. Having never been someone who has a great affinity for ePortfolios, it seemed that having two to keep on top of was beyond me. Thankfully I was supported through that rocky time by a number of colleagues and I was able progress with my training.

After a great deal of revision I managed to pass all aspects of my FRCA and FICM exams at the first sitting. Luckily for me there was abundant help on offer from the enthusiastic Consultants in South Yorkshire. As with most of my contemporaries I found the months leading up to the exams to be very stressful, especially as the FICM exams are ‘high stakes’ in the sense that they are required prior to entering the final year of training.

Not surprisingly, spare time is at a premium as a dual trainee. None the less I consider myself to have been very lucky with my personal life during my registrar training, having got married and had a child. My wife also works shifts as a part time Paediatrics trainee doctor; as such it is challenging to coordinate family life, childcare and our careers. I enjoy socialising, playing sports and dabbling at woodwork in the limited time that I am not either working or changing nappies.

If I could go back in time then I would certainly undertake dual ICM/Anaesthesia training again. It has been highly rewarding and challenging in equal measure and I have been happy to apply myself to improving patient care in both specialities. In hindsight, life would have been much less stressful had I not underestimated the commitment required in order to provide ePortfolio evidence of training and progress in two specialities.

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