ICM Training FAQs 2024
Stage 1
During your anaesthetic placement, aim to have your IAC signed off in the first three months. You should be treated as an CT1 anaesthetist for the whole of the year and receive the same training opportunities as them. This includes attendance at teaching sessions, locally and regionally. There is no requirement to undertake an Obstetric module, but in all other respects you should partake in the anaesthetic CT1 on-call rota, and be exposed to a wide variety of anaesthetics that will vary based on the hospital you are in.
We would recommend exposure to a range of theatre lists, including those with a high turnover of cases requiring Endotracheal tubes to improve fluency and lists with complex cases requiring lines, intubation and possible ICU/HDU post op care. It will also be useful to have exposure to paediatric and obstetric lists.
We are highly supportive of Dual EM & ICM and Dual/Triple Medicine & ICM StRs completing their first year on the ICM CCT Training Programme in Anaesthesia, however this will be dependent on local availability. TPDs are urged to place a dual/triple StR (who has been recruited to ICM later on in an EM or Medicine training pathway), into Anaesthesia first in order that the ‘catch up’ of stage 1 ICM learning outcomes can be achieved.
Since the introduction of the 2021 ICM curriculum, the design and focus for the entire curriculum and aim for all HiLLOs is for it to be outcome-based, moving away from the previous time-based programme.
Therefore, Intensivists in Training (IiTs) must be able to demonstrate the capabilities as described in the key descriptors of each HiLLO, and in the case of the Medicine HiLLO 11, to a capability level 3. The GMC's General Professional Capability Domains are integrated within the HiLLOs, so do not need to be separately identified.
Dependent on the capacity, capability and prior agreement with the lead trainers within the region, IiTs during their medicine placement may have the opportunity to seek additional development and maintenance of skills/experiences that complement both medicine and intensive care, so as long as the doctor can satisfy their HiLLO requirements. This may include a placement in EM (maximum 6 months), or specialty medicine placements (such as cardiology, respiratory, etc) in addition to acute medicine and other appropriate locations. The Stage 1 Medicine outcome-based capabilities can still be met within an agreed placement timeframe between the deanery and the IiT.
Stages 2 & 3
ICM StRs should not only maintain skills achieved in their anaesthetic year, but also enhance them from a level 2 to level 3 capability. This is done through intubations and sedation in the unit as well as regular exposure to cardiac arrests, trauma calls and emergency department calls. Specialty ICM placements in neuro, cardiac and paeds will also enhance airway skills. ICM StRs may find it helpful to have some scheduled days in theatres to maintain airway skills in a more controlled environment if insufficient experience available elsewhere. It may also be a suitable application of Educational Development Time (EDT).
A logbook of airway interventions is an ARCP requirement.
Yes. You and your Educational Supervisor should take into account your previous experience when assessing whether HiLLOs have been met and maintained. For example, you can utilise your paediatric block experience as evidence for paediatrics and maintain this through reading or online modules. It is important to maintain your logbook of any neuro, cardiac or paeds encounters during Stage 3: this is important evidence of maintenance of your skill /capability level.
Yes. The curriculum is outcomes based. If you and your trainers agree that the learning outcomes and capabilities can be met across the whole year (e.g. a 6-9 month block in a General ICM placement, with the remainder of the time being spent in a Specialist ICU setting). This will be highly dependent on availability and flexibility of local programmes. However, we would support our most senior ICM StRs spending valuable training time (and gaining Stage 3 capabilities) in a placement where they may be considering post-CCT employment.
It is vital for the maintenance of your anaesthetic experience to continue to see critically unwell patients requiring resuscitation post Stage 1 training. If you are having difficulties with your local department please raise this with your ICM Regional Advisor and trainee representative. If this fails to be resolved they will also report this to the FICM StR Sub-Committee.
General
The curriculum is now outcomes based so there is no required number of procedures each year. The logbook summary is the only requirement to be presented at ARCP to allow guidance and facilitation to any exposure that may help consolidate future training.
Please review FICM's ARCP national checklist which should be adhered to by ARCP panels and ICM StRs.
Arrangements for EDT time are organised at a local level by hospital trusts/boards. Many trusts/health boards have facilitated EDT time to be used at home if still available to return to hospital if required for clinical issues.
SPA stands for “Supporting Professional Activities" and is also known as EDT: 'Educational Development Time'. The Faculty of Intensive Care Medicine (FICM) recommends that Stage 1 and 2 Intensivists in Training receive up to 2 hours per week, while those in Stage 3 should get up to 4 hours per week. Hospitals may allocate this differently, but its purpose is to facilitate activities that align with the GMC’s Professional Capabilities Framework. SPA time is distinct from OFF days, Annual Leave days, or Study Leave days. If you intend to be unavailable or away, it should be booked as an annual leave day. If attending a course or conference, it should be marked as study leave. Most hospitals might permit SPA time off-site, but you're expected to be reachable and ready to report for duty in cases of emergencies. Its use encompasses planning educational activities, audit/QIP activities, management activities, research activities, or attending specific clinical sessions.
Educational Development Time | The Faculty of Intensive Care Medicine (ficm.ac.uk)
There are several pathways to escalate concerns. In the first instance, we would advise speaking to your Educational Supervisor or Faculty Tutor. If the issue remains unresolved, your TPD or RA are other sources are of support. With the outcome from the national StR survey we have setup a new national reporting system which you can access through your regional representatives. This is for reporting, anonymously, any issues that cannot be resolved locally or require a central FICM led intervention to resolve.
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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