Let's Talk Questions Round Up

On 3 July we ran our first 'Let’s Talk' event, following the release of the 2024 Membership Survey Report. We were unable to answer all the questions posted in the meeting chat on the night due to time constraints, and so have addressed a number of them in the following Q&A.

We look forward to holding more 'Let's Talk' events in future, so let us know what you would like to discuss.
 

Can you elaborate on the advantages of disaggregation from the RCoA?

The Faculty has eight parent Royal Colleges but our governance and finances are determined by the RCoA acting under the terms of its Royal Charter.

With the creation of the standalone ICM CCT, more people are now entering training who do not have a background in anaesthesia or are members of the RCoA. The RCoA represents the interests of anaesthesia and patients under the terms of its Royal Charter.  It is increasingly clear to both FICM and the RCoA (supported by our other parent Royal Colleges) that to meet the needs of future ICM patients and the ICM workforce, the interests of ICM are best served by the formation of an independent College of ICM governed by its own Royal Charter. This will allow us to fully reflect and support the diversity of our ICM medical members, have full control of our own finances and governance and advocate directly for the ICM workforce as distinct from and different to that of any of our parent Royal Colleges. 

However, it is important to note that administrative disaggregation between organisations is not the same thing as ICM and anaesthesia disaggregating within the health service. We envisage both specialties continuing to work together closely, as would an independent college with the RCoA.
 

What is the Faculty’s view on expansion of National Training Numbers and ACCPs?

Faculty Board is clear that delivery of critical care services in the UK should be led by an appropriately trained consultant ICM physician. In order to ensure an equity of provision across the UK, we continue to advocate for expansion in ICM National Training Numbers beyond the current level. Intensivists in Training (IITs) are training to be the future clinical and professional leaders of intensive care.

The ACCP workforce is a different professional group who provide ongoing patient care as members of the MDT. Their training and professional career needs are different from IITs. They are able to provide support to an intensive unit that enables and facilitates the training of IITs and other doctors eg Anaesthetists in Training.

The Faculty is clear that there is a need for both IITs and ACCPs in the ICM workforce and has recently released a set of FAQs on the role of ACCPs to clarify our position.
 

As a single ICM Trainee, what are the prospects of being hired as a standalone intensivist post-CCT? Could the faculty provide insight and reassurance on this?

The Faculty has a dedicated Careers Hub in which we showcase the variety of ICM careers available. FICM Regional Advisors and our Training Committee have worked with the Careers, Recruitment and Workforce committee to ensure that employers are encouraged to advertise ICM consultant posts in a way that reflects the different backgrounds of those working in ICM so that they are equally open to single and dual ICM CCT holders. Moreover, the number of Special Skills Year Modules available to those in single CCT ICM training has grown, increasing the variety of additional skills available to employers as well as meeting the interests and aspirations of those in training.

As the ICM medical workforce has grown, we are seeing ICM single CCT holders taking up posts in ‘district general’ type hospitals as well as the larger teaching centres.

We would advise all IITs coming to the end of Stage 2 and considering future consultant posts to make informal contact with the Clinical Directors/Clinical Leads of ICM services where they wish to work to make them aware of their interest. CDs tell us they find this helpful in terms of deciding when to advertise ICM posts.
 

Are there plans to make ICM a core training specialty starting at CT1? By the time you join at ST4 a lot of trainees are dual training which sometimes means clunky rotations  and repetition of competencies.

At present there are no plans to apply for ICM to be considered a core specialty for postgraduate training. The Faculty considers that the number and variety of core medical training programmes which provide entry to ICM training (ACCS, IMT, CAT) allows for flexible career decision making. Equally, ICM does also benefit from being part of multiple existent core programmes, allowing doctors from multiple backgrounds to be exposed to ICM and discover it is the specialty for them.

The Training, Assessment and Quality committee of the Faculty is aware that for many doctors entering the ICM CCT programme at different stages there continues to need to be a bespoke approach to training to recognise prior experience and ensure the appropriate competencies needed for each stage of ICM training are able to be achieved as efficiently as possible. We support the aims of NHS England in its commitment to improve the working lives of doctors in training and urge the health leadership in the devolved nations to ensure they match these aspirations.
 

Are dual specialty trainees disadvantaged by having to pay to both colleges and with extended training to up 10 years?

Faculty membership provides those in ICM training with access to the ICM portfolio and specific support for the ICM CCT programme from the Faculty secretariat and our committees including our StR subcommittee.  There is a cost associated with this provision which no other organisation can provide. All IiTs who are also members of one of our parent colleges also receive a discount on their FICM membership fees. This discount does not apply for single specialty ICM IiTs.

We recognise that individuals may choose either single or dual ICM training and one element of this decision may be the costs associated with training in each CCT. We continue to work closely with RCEM, RCP and RCoA to ensure that we work together on matters that impact on our mutual members and ensure that the money paid in membership fees is utilised as effectively as possible.
 

How does the faculty address the perception among some anaesthetic intensivists that non-anaesthetic trainees are not as qualified/sub-par for the role of intensivists?

The Faculty remains committed to fostering a positive, inclusive, and supportive training environment as well as continually improving the ICM training experience for all its Intensivists in training (IITs). The most recent published StR survey highlighted in some areas a disturbing unequal treatment of IITs whose training backgrounds were not in anaesthesia.

We have highlighted this issue to all our partner Colleges and will continue to work to ensure colleagues are aware of and are taking steps to address the concerns highlighted e.g. by working with training leads in our partner specialty Colleges and releasing appropriate joint guidance for their trainers e.g. Best Practice for Management of Intensivists in Training.

We encourage IITs to report any issues with regards to unequal training opportunities within regions to their local FT and/or RA in the first instance or to the StR Subcommittee. We are also creating a National Reporting System to allow issues that could not be addressed locally to be brought to our attention.
 

With regards to exams changes where FFICM MCQ can be done in Stage 1, will that mean that Stage 2 curriculum questions will be removed from future FFICM MCQ exams?

The Faculty has published a set of FAQs relating to the announcement of recent exams eligibility changes and greater flexibility for candidates applying for the exam. It is important to note, as announced at the time, that the content, standard and structure of the examination has not changed. The exam standard is and has always been set at Stage 2 ICM training and so questions relating to all aspects of Stage 2 ICM remain in the exam. It is important to note that the MCQ now can be sat in Stage 1 but does not have to be – IiTs are now afforded the opportunity to sit the MCQ early should they wish and, vitally, should they and their trainers feel they are ready for it. We will collect data on how future candidate cohorts perform at the MCQ and ensure this is communicated to members.