Paediatric Intensive Care Medicine

What is the role of PICMISAC?

While FICM sets the training requirements for adult Intensive Care Medicine (ICM) the RCPCH are the GMC-designated lead College for the subspecialty of PICM, via their NTN Grid programme.

The approved subspecialty curriculum and training requirements for PICM have been written and set by the Paediatric Intensive Care Medicine Intercollegiate Specialty Advisory Committee (PICMISAC). The purpose of the PICMISAC is to supervise the development and delivery of training and assessment standards in PICM as set out by its parent specialties.

PICMISAC has representation from the RCPCH, FICM, the Royal College of Anaesthetists (RCoA) and the Paediatric Critical Care Society (PCCS). The application process for entry to PICM CCT subspecialty training is overseen entirely by the RCPCH and runs as part of their NTN Grid training programme. 

Who is eligible for a Grid application for sub-specialty training in PICM?

Intensivists in training must have a current NTN in ICM and have either the Primary FRCA, MRCEM or intermediate FRCEM, MRCP (UK) examinations or equivalent. Intensivists in training in a single or dual CCT in ICM can undertake sub-specialty accreditation in PICM.

Doctors undertaking a CCT in ICM should apply for PICM Grid training before the end of Stage 1 and must have completed Stage 1 of the ICM Training Programme (ST4) by the time of entry into PICM training. Entry into the PICM subspecialty programme is via an open and competitive national application process that takes place annually.

The application window for PICM Grid usually opens in October. For an indicative timeline please see the RCPCH website.

Are you considering single CCT ICM with sub-speciality training in PICM?

Single ICM CCT holders may incorporate the PICM training into their existing programme without an extension to their training time. Paediatric Intensive Care Medicine is an indicative 24-month whole time equivalent (WTE) programme of training with a requirement for intensivists in training to have completed 6 months of anaesthesia training before application to the programme, which ICM CCT holders complete during Stage 1.

Single ICM CCT holders successfully recruited via the RCPCH’s PICM Grid programme can then incorporate their ICM Training Stage 2 Special Skills Year (SSY) into the PICM subspecialty programme. Outcomes achieved in the PICM programme can be double counted against the key capabilities required for ICM HiLLO 13: Paediatric Care at Stage 2 and 3.

The table below demonstrates how it might be possible for a doctor undertaking a single ICM CCT to incorporate the PICM subspecialty into the ICM programme without a prolongation of training. However, the implementation of the subspecialty training does depend upon local circumstances and as such, intensivists in training undertaking PICM subspecialty training may require an extension to their overall training time to meet the requirements of both curricula.

*All training times are indicative

Can I do dual training in ICM with sub-speciality training in PICM?

Intensivists in training undertaking Dual CCTs in ICM and a partner specialty (with either Acute Internal Medicine , Emergency Medicine or Anaesthesia) can also apply for the PICM subspecialty programme. Undertaking Dual CCTs and sub-specialty recognition, however, will result in a significantly prolonged period of training of an additional indicative 24 months.

The indicative minimum duration for ICM Dual CCT programmes is 8.5 years; these programmes have been agreed by the Faculty and its partner colleges based on the mapping of capabilities between the respective curricula. As the ICM Special Skills Year is not part of a dual programme, there are limited opportunities for PICM training to cross count the capabilities for all the curricula, hence this will take longer. Subject to local agreement on how capabilities achieved during the PICM subspecialty programme can be incorporated into the Dual CCT programme, it may be possible to undertake the PICM training in less than the indicative 24 months required.  

As such, any intensivist in training already undertaking dual CCTs in ICM and a partner specialty who also wishes to apply for PICM subspecialty recognition requires the explicit support of their Postgraduate Dean before applying for PICM.  Postgraduate Deans should also be made aware of the funding implications of Dual CCT trainees undertaking PICM. The Training Programme Directors for each of the dual specialties should also be involved in these discussions due to the possible impact on rotations. Consideration should be given to the local service need and the workforce requirements for PICM.

In addition, intensivists in training should also be aware of the future requirements of revalidation in dual specialties and an additional subspecialty.

How is subspecialty training in PICM assessed?

Intensivists in training that are successfully recruited to the PICM subspecialty NTN Grid training programme will record their progress using the RCPCH’s ePortfolio system. Their progression will be monitored through the RCPCH’s PICM curriculum by their Paediatric ICM Educational Supervisor. They will have to ensure that they continue to maintain their ICM LLP in parallel.

On successful completion of the PICM subspecialty training programme, the College Specialty Advisory Committee’s (CSAC) progression form will be signed off by the Chair of the RCPCH’s PICMISAC. The completed CSAC progression form should be uploaded as a Personal Activity in the doctor’s ICM LLP account and linked to the PICM SSY module in Stage 2.  

As a single CCT holder in ICM, can I still undertake a PICM Special Skills Year outside the PICM Grid?

The GMC regulations state that a trainee must have undertaken their PICM training via the RCPCH NTN Grid (entered via a competitive national application and interview) in order for that training to count towards CCT subspecialty recognition. However, if it is available locally, single CCT intensivists in training may still undertake a Special Skills Year in PICM but will not receive any official CCT subspecialty recognition for doing so. Whilst PICM subspecialty training and an independent PICM Special Skills module contain competency crossover, they will not be identical (due to the length of training) and will not have the same final learning outcomes.

Within the Special Skills Year, ICM Specialty Registrars should follow the approved PICM training curriculum as appropriate to their level of prior training and experience in the subspecialty. Intensivists in training following a single ICM CCT Programme should begin their PICM SSY following the Basic level PICM curriculum; whilst it may be appropriate, depending on their level of previous PICM training, for them to begin to achieve some Advanced level capabilities, this will be at the discretion of local PICM trainers in liaison with the doctor’s ICM Educational Supervisor.

Supervision and assessment of these doctors would be carried out as established in PICM training. Doctors in ICM training would be required to demonstrate progression in PICM as per the established assessment system and include this evidence as part of their portfolio to be review by their ICM Educational Supervisor. In addition, they will be required to sign off the PICM SSY Module in the doctor’s ICM LLP account. When you have accrued all the evidence for the PICM SSY Module and it has been uploaded in the ICM LLP, a Learning Outcome Completion (LOC) form can be initiated for the module and sent to your Educational Supervisor for approval for ARCP purposes and progression to Stage 3.

PICM curriculum

Please note that the full syllabus for PICM training is not reproduced here and intensivists in training should refer to the full PICM curriculum available via the RCPCH website. For reasons of space, the curriculum has not been reproduced within this guidance. In addition, the curriculum is maintained by the Royal College of Paediatrics and Child Health; whilst the principle of doctors in ICM training following this curriculum is maintained, it is not pragmatic to update this guidance document to match every individual change to the external PICM curriculum.

Intensivists in training who conduct PICM training outside of the official Grid subspecialty pathway and who subsequently wish to apply for CESR Equivalence of this training must do so according to the regulations of the GMC in force at the time.

Where can I find more information?

• Paediatric Intensive Care Medicine Intercollegiate SAC | RCPCH
• RCPCH Paediatric Intensive Care Medicine-Sub-Specialty
• FICM ICM Curriculum: Supporting Excellence Special Skills Year Handbook – Paediatric Intensive Care Medicine