Rotational Training in ICM

RECOMMENDATION 1: Heads of School (HoS) and Training Programme Directors (TPD) to review and look to minimise the number of rotations required to complete each stage of training

In all Stages of training

1. Recognise the additional challenges for dual/triple IiT. HoSs and TPDs should address training needs for 2/3 different specialties, with close working relationships between partner specialty TPDs and the Deanery.

2. Dovetailing placements in the same training location for IiT transitioning between stages, or dual/triple CCT IiT moving to/from partner specialty programmes.

Within Stage 1

3. It is possible to gain all the capabilities required to complete Stage 1 training without needing to rotate if the IiT and TPD can see no detriment for future learning (or for other IiTs on programme). The IiT has undertaken a core programme, and consideration may be given to continuing in that training location, depending on discussions between the TPD and IiT, but also considering the experiences and requirements of all IiT on the programme.

Within Stage 2

4. Training could be delivered flexibly to minimise the need for 3-month rotations as much as possible within Stage 2, recognising that specialty ICM placements and SSY choice may negate this. 

5. The need to visit tertiary units for cardiothoracic, neuro and paediatric ICM can potentially be aligned with the requirements of the other clinical domains to maximise curriculum coverage and be useful to gaining capabilities for Stage 3.

6. Consideration may be given to having 4-month or longer placements in tertiary units for subspecialty ICM training, understanding that complementary evidence and competence can be gained in additional HiLLOs to those subspecialty ones.

Within Stage 3

7. The requirement to rotate will depend on the individual IiT’s training needs and can be structured flexibly across the year, provided the curriculum requirements are met. While it is generally expected that Stage 3 training will comprise two placements, either as a 6/6, 9/3, 8/4 or other suitable split between general and specialist units, this is not mandatory. A single 12-month placement in one hospital may also be appropriate in some cases. The split and location of Stage 3 placements should be determined collaboratively between the IiT and their trainers to ensure the most beneficial training experience and to support the IiT’s future career intentions. 

    

RECOMMENDATION 2: Each Deanery to review the provision and delivery of educational supervision

1. Consideration to ensuring ICM Faculty Tutor involvement when an IiT is in a partner specialty placement, either in Stage 1 or as a Dual/Triple CCT. This can provide continuity and contact with ICM, and support IiTs during what can often be difficult and challenging transitions between specialties, even within the same hospital. This is a recognised aspect of the FT role and can generate significant workload including providing an ESSR and input to ARCP. This should be factored in and acknowledged in the FT’s remuneration.
2. Consideration of implementing stage specific Educational Supervision. If IiTs are to be placed with an ES for a stage it is paramount that supervision is of high quality. It may be prudent for an ES to focus on a particular stage of the curriculum to ensure they have a detailed understanding of what IiTs will need to accomplish in that stage (e.g. ES for Stage 1, ES for Stage 2 with experience of SSYs, ES for Stage 3).
3. Consideration of implementing Educational Supervision for the entire programme. One of the significant benefits cited in maximising the length of placements is continuity of educational supervision. This can be beneficial for the IiT and trainer alike. The ES will have a better understanding of the IiT’s needs, development and progress. It also allows the IiT to make longer-term plans. See the case study examples from the East Midlands and South East Scotland here.
4. Deaneries should ensure that training requirements discussed and agreed at ARCP are clearly communicated to trainers in the IiTs next rotational placement, as best practice. This will facilitate a new rotation placement and mitigate the challenges described above.

RECOMMENDATION 3: Intensivists in Training to be provided with advanced notice of rotations

Whilst there is always a need for flexibility within the training programme to the benefit of all IiTs, consideration should be made to inform them of their likely rotations as far in advance as possible. This will require close liaison with partner specialty TPDs for those IiTs on the Dual/Triple ICM CCT Programmes.  

1. In Stage 1 this should comprise the remaining aspects of their Stage 1 training on joining the CCT programme (some doctors have pre-existing training from other specialties and out of programme learning they can count). The Minimum Advanced Notice period: 8 weeks prior to starting Stage 1.
2. Stage 2 should be the details of their Specialty ICM and SSY placements. This requires close liaison with partner specialty TPDs, for IiTs on a Dual/Triple ICM CCT Programme. Notification timescales should be considered closely by TPDs and acknowledging the complementary transferable competence and evidence that can be gained across specialties.
3. The Stage 3 programme should be tailored to the future career aspirations and advanced skills (including leadership and management) and needs of the IiT. Longer timescales for notification of placements are impossible to mandate but close communication between IiT and TPD will ensure timely decisions.

Having advance notice of rotations can help mitigate the stresses of moving between placements, allowing IiTs to plan effectively. Flexibility and understanding are essential. IiTs and TPDs should feel able to request changes where mutually agreeable, especially if interest areas change or if a department has limits on the number of IiTs it can train at a particular stage of the curriculum. Additionally, rotation changes may occur at a later stage because of ARCP outcomes, statutory leave, or a change to working patterns (e.g., LTFT working).

RECOMMENDATION 4: Intensivists in Training (IiT) should be involved in choosing their rotations

Providing IiTs with an opportunity to be involved in the planning of their rotations will provide them with a greater sense of control over their training programme. We recognise that several Deaneries already allow IiTs to preference their placements in Stage 1 and all IiTs will be involved in the decisions made around their Stage 3 placement requests. Although it is desirable to involve the IiT in aspects of their training at Stage 1, consideration must be given to safe patient care, and the collective needs of all IiTs in the region’s programme. IiTs should be reassured that hospitals in their region will be appropriate for their level of training as assessed by the Deanery, TPD and Regional Advisor.

We continue to support the best practice of Schools to enable, where appropriate, extra-regional placements, such as an OOPT for a Special Skills Year (SSY) where the SSY is not offered in the base region, at the Dean’s discretion and in line with the IiT’s educational needs. Similarly, this would be the case for inter-deanery transfers, regardless of the causative request.