Dual/Triple CCTs FAQs
General Questions
The GMC do not recognise any such entity as *a* Dual/Triple CCT. There are Dual/Triple CCT*s*. There is the opportunity for doctors who wish to train in ICM to also concurrently train in another CCT specialty. These curricula and their respective recruitment and assessment processes are completely independent of each other, but as a result of common competencies shared by the curricula the total training time can be shortened by virtue of a Dual/Triple CCTs Programme. It cannot be emphasised enough that it is the programme that is dual/triple: doctors cannot be appointed to *a* Dual/Triple CCT. A doctors must be appointed to both primary specialty programmes which lead to a CCT in fair and open competition according to their suitability to train in that specialty as laid down in the eligibility criteria of the respective curriculum and according to that specialty’s selection process.
The indicative minimum timeframe for Dual CCTs with ICM and a partner specialty is 8.5 years. This is 18 months longer than standalone ICM CCT training (7 years). Please see the Dual CCTs guidance documents.
The (Acute Internal Medicine, Renal Medicine, Respiratory Medicine) and GIM and ICM CCTs are outcome-based programmes; each of the CCTs have an indicative programme duration of 7 years. Following, a comprehensive mapping exercise, the capabilities and outcomes that can be achieved in all three curricula have been identified. As a result, the Triple CCT programmes have an indicative programme duration of 8.5-9.5 years. Please see the Triple CCTs guidance for further details.
Dual CCT programmes with ICM exist for Anaesthetics and Emergency Medicine, The Dual Programme Guidance is available on the Dual/Triple CCTs page.
From August 2022, the JRCPTB fully incorporated General Internal Medicine (GIM) into all Group 1 medical specialty CCT training programmes, and it was no longer possible to train in these specialties in isolation – all physician CCTs in the Group 1 medical specialties are Dual CCTs by default. Where these specialties already had established Dual CCT programmes with Intensive Care Medicine – for Acute Internal, Renal & Respiratory Medicine – the GMC approved the Triple CCT programmes.
Yes. It is possible to subspecialise in PICM on the Dual ICM CCT Programme. Please see section 3.5 (p.18) of the 2021 ICM curriculum.
Please follow these links for further details and support:
1. Information for Anaesthetists and Paediatricians
2. RCPCH - Information on PICM subspecialty recognition as a FICM IiT
Please see the information on the Recruitment pages of the website.
Doctors are able to apply for either specialty first and it is expected doctors may apply for both at the same recruitment episode in order to increase their appointment opportunities. They will, however, in the event of being successful at both interviews have to choose one or other specialty. It will be down to local regions to advise their applicants based on their individual circumstances about which specialty they should apply for first.
Yes. It is a stipulation of COPMeD and the Department for Health & Social Care that the two/three CCTs must be undertaken in the same Deanery.
No. FICM and its partner colleges have agreed to each accept the other’s SLE materials as part of the dual/triple counting of assessments. Doctors will be expected to maintain individual portfolios for each programme demonstrating achievement of each curriculum’s learning outcomes.
Whilst such doctors would indeed have to remain solely in ICM training, it is unlikely that this eventuality would occur. Doctors already in one partner specialty applying to enter the other with over a year of experience are likely to be very strong candidates; this would be analogous to doctors on the ACCS (Anaesthesia) Programme applying for ST4 Anaesthesia, who are competitive in comparison to CAT applicants. Equally, doctors are not entitled to dual training – they must apply for each component in open competition, as with any primary specialty.
Doctors undertaking blocks of ICM outside of the ICM CCT programme are expected to register as Affiliate Trainees of the Faculty. Doctors entering Higher Specialty Training (HST) are expected to demonstrate that they have undertaken training commensurate with Stage 1 level ICM as defined by the standalone CCT in Intensive Care Medicine curriculum. Such doctors can then apply for Affiliate Fellowship of the Faculty (no post nominals). If these Affiliate Fellows then wished to undertake further training to Stage 2 level, they could sit the FFICM Final examination for full Fellowship of the Faculty, with the post nominals FFICM. If they remain unsuccessful in entering ICM Higher Specialty Training, then an option would be to pursue the Portfolio Pathway for entry onto the Specialist Register for Intensive Care Medicine.
ICM Triple CCT FAQs
Yes, where teaching is relevant to both ICM and GIM, it can count towards both specialty teaching hours.
No, stage 3 can be completed in any order although GIM on calls must be completed within the final 12 months of training leading up to your CCT, to maintain capability. If your final year of training is a 12 month ICM placement, contemporaneous acquisition and maintenance of GIM capabilities can be achieved by 'release' from ICM for GIM sessions on an ad hoc locally agreed basis, and via applicable practise and experience in ICM/other environments.
No, the requirement is to complete 2 years (and a further 3 months in AIM/Renal) of the medical specialty in Stages 1 and 2. For those who join ICM training at the end of ST5, this will already have been completed. There remains the need to obtain some GIM training in the last year as above to ensure that GIM capabilities are current. Medicine placements should be limited to the required levels after the main experience has been obtained to ensure ICM Stage 1 & 2 capabilities are also achieved. The later an Intensivist in Training (IiT) commences triple CCT training, the likelihood of the minimum described period of training will be lengthened, as there will have been less time to dual/triple count capabilities. If anyone has any queries regarding this, please contact us for advice via: contact@ficm.ac.uk
All curricula are now outcome based, as per the GMC’s Excellence by Design standards & requirements. Therefore, extensions to training time should only occur if you are deemed not to have met the outcomes. This includes the necessity to ensure all capabilities are current and that there is adequacy of experiential learning.
Yes. Some experience in ICM can count towards GIM outcomes where it is relevant. Examples can include looking after patients with GIM related illnesses on ICU, end of life care and reviews on the wards and in emergency departments.
ICU follow-up clinics can count towards some of the GIM clinic requirement but not all. To fulfil the clinic requirement for GIM there must be some experience of medical specialty or GIM clinics.
The FICM & JRCPTB would support a doctor in training, who was part of the ICU outreach role covering medical wards and admissions, counting this towards the GIM requirements of HILLO 1 of the Internal Medicine CiPs. However, time also needs to be undertaken as the medical StR leading/overseeing the medical take to fully achieve this capability. This includes experience in the final year of training.
Yes, patients who are a part of the acute unselected medical take (for example, patients with IECOPD or OOH cardiac arrest) can count towards the requirement to see 750 patients overall presenting with acute medical problems.
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For ICM Trainers
The Faculty and the Colleges appreciate the difficulties Dual/Triple CCTs Programmes may cause for TPDs and Deans. Entry into the standalone ICM CCT Programme is entirely open to any doctor who has completed one of the designated Core Programmes – these appointments are not ‘badged’. Whilst you may get four ICM doctors with a CAT background in one year, in a second year you may get four with an IMT background (although naturally fluctuations of this kind are extremely unlikely).
The concept of ‘badging’ posts does not fit in well with the principles of fair and open competition on which the entirety of specialist medical recruitment is now predicated. In a system of ‘badged’ posts, the programme is set, and the doctors are recruited according to programme availability. For example, a dual programme consisting of Anaesthesia and ICM would only be able to recruit doctors into ICM training who already possess an NTN in Anaesthesia. This would exclude doctors with a physician or emergency medicine background from applying for training in ICM, even though those candidates may have scored higher in interview than the anaesthetists in training who finished below them but were offered ST3 posts in ICM because there were a greater number of Anaesthetic/ICM programme vacancies. Under those circumstances we could end up not recruiting the most suitably qualified doctors to ICM. See the Recruitment pages for more information.
Each region can by default only ever have as many Dual/Triple CCTs as it has single ICM CCT posts. The dual or triple element may come from an ICM ST3 doctor applying for a CCT post in a partner specialty, or vice versa from a doctor who is, for example, already an ST4 in Acute Internal Medicine, applying for one of the advertised ICM posts.
The Faculty, RCoA, RCEM & JRCPTB have structured the requirements of the Dual and Triple CCTs Programmes to be as flexible as possible to deliver locally, and it will be necessary for the respective TPDs to work very closely together to plan rotations. There will of course be gaps in rotations (there always are) but these will be identifiable in advance and can be planned for; an Anaesthesia TPD will know that in the event of one of their ST4 Anaesthetists being successful in applying for one of the two standalone ICM CCT posts in their region, that this IiT will leave their rotation for 12 months of medicine training. However, the requirements of Stage 1 ICM are not linked specifically to ST years, so there will be room within the combined programme for the TPDs to arrange movement of doctors in training through the units. In addition, once the doctor has achieved the requirements of Stage 1 ICM, the degree of dual-counting and competency overlap between the respective CCT programme curricula mean that any such movement will be minimal.
Gaps in rotations are managed by various methods, including slot sharing options and recruiting to vacant slots. Deaneries will manage the amount of Dual/Triple CCTs Programmes in their regions to best ensure a consistent supply of doctors. Alternatively, as each CCT is fully funded and combining the programmes will result in a saving, there should be funding available for LAT appointments to fill gaps. It will be necessary for TPDs to work very closely together to maintain rotations.
No. Candidates entering the ICM programme from Internal Medicine Training require novice anaesthetic training equivalent to CT1, and those from Core Anaesthetic Training require training in Medicine. This training is provided ‘in-programme’. ICM TPDs manage the ICM-specific components of the dual programme, such as the medicine requirement. ICM TPDs also work closely in tandem with all partner specialty TPDs in the planning and organisation of Dual and Triple CCTs Programmes to meet the learning outcomes required of all curricula.
The Faculty advises that out-of-hours (OOH) experience be anchored by the location of the in-hours training. Thus, when doing anaesthesia, the OOH experience would be in anaesthesia, and vice versa for ICM. For those modules which are dual counted, Intensivists in Training (IiT) must fulfil the curriculum capability requirements for both specialties and OOH work is intrinsic to both areas. For example, experience in neuro-anaesthesia will often include experience in neuro ICM, and the on-call may therefore be experienced in both. The detail should be agreed by the respective specialty's Tutors, with referral to the regional training committees if in doubt. In the event of disagreement which cannot be resolved, the default would be 50:50. It is accepted that in some hospitals, IiT undertaking blocks of anaesthesia may be required to cover the ICU on-call as a function of service requirements. There may be occasions in the final stages of triple CCT training, that there are some local arrangements to ensure current capabilities are maintained in all curricula.
Yes. To support workforce planning, it is vital that ICM has its own set of National Training Numbers.
NTNs are, in essence, merely identifiers of how many doctors in training exist in each specialty. Therefore, whilst a Dual CCTs Intensivist in Training would hold two NTNs, they would not need to use both. As long as both are allocated, one NTN would simply be greyed out against their name. For practicalities of delivery, the FICM recommends that whichever specialty the doctors enters first, be it ICM or the partner specialty, that particular NTN should be used on their documentation throughout training.
When Intensivists in Training (IiT) are undertaking modules of full-time ICM, they will fall under the remit of ICM trainers, and vice-versa for their partner specialty. ICM trainers and TPDs will also assume responsibility for the planning of the Dual and Triple CCT complementary modules, as dictated by the individual doctor’s requirements after completing their respective Core Training (i.e. Medicine for doctors coming from CAT, Anaesthesia for doctors coming from IMT), whilst working with their partner specialty TPD counterparts to arrange the timing of those modules within the overall Dual/Triple CCTs Programme. In those areas where competencies are dual counted, such as neuroanaesthesia for the ICM/Anaesthesia Dual CCTs programme, IiT may remain under the remit of the Anaesthesia trainers; however, it will be up to those IiT to ensure that the relevant assessments are completed and portfolios maintained to demonstrate the acquisition of both curricula’s competencies as part of the ARCP process.
This is managed by the deaneries at a local level. Much depends on whether the difficulties in question are related to ICM or their partner specialty. If the problems occur in those areas where competencies overlap, the respective Training Programme Directors need to work together to resolve them.
