Open letter to all 2021 ICM National Recruitment applicants

25 March 2021

To all applicants for ICM National Recruitment this year

The 2021 ICM Recruitment round has been difficult. As the organising bodies of the Faculty of Intensive Care Medicine and Health Education England West Midlands (HEEWM) co-ordinating the process, we acknowledge and accept there will be many unsuccessful applicants this year who are feeling angry, upset and worried for the future. The numbers involved this year are worth highlighting - there were 595 applicants of which 553 were longlisted for a maximum of 190 posts (final post numbers have not yet been confirmed by all regions) giving a competition ratio of 2.9:1, therefore a considerable number of applicants will unfortunately not have been successful this time. This has been the most competitive year for ICM national recruitment since it began in 2012 and this is undoubtedly due to many factors associated with the current pandemic.

The best way to reduce this competition is to increase the number of ICM posts, however the Faculty has no control over the number of posts available each year; they are allocated by Health Education England and the Department of Health and Social Care. We were fortunate to receive an additional 114 posts across the four nations of the UK in 2020 but we were informed that this increase would be non-recurring. We have consistently lobbied for more ICM posts as this is the only way to help improve the service provision in Critical Care. As we have repeatedly stated, increasing the number of ventilators and ICU beds is futile if there is not the right number of trained staff to care for the patients that need them.  



In the years prior to 2020, we have always run ICM National Recruitment as a face to face process with multiple stations and panels of interviewers to ensure each candidate was seen and assessed by at least 10 different interviewers. The constraints against holding a face-to-face process both last year and this year meant that this simply was not possible. The speed and severity of the first wave of the pandemic in 2020 meant that the whole process had to be re-designed in a very restricted time period to deliver an ICM recruitment round at all. For the 2021 recruitment round, we had originally hoped to be able to hold some form of online interviews, but the arrival of the second wave of the pandemic meant that this became impossible. The ICM recruitment process has always been (and always will be) devised and delivered by working Consultant Intensivists, to ensure that the people currently doing the job the applicants are training for have the main responsibility for selecting the candidates best suited to progress into ICM training. These very same Consultant Intensivists were working shoulder to shoulder in intensive care units across the United Kingdom with the applicants themselves, other trainees, SAS doctors, practitioners, nursing staff and wider critical care team to deliver safe and effective care to the unprecedented numbers of critically ill patients with covid, with numbers in the second wave peaking at around the time we would have been trying to deliver online interviews to hundreds of applicants.


Rationale for change

The alternative of cancelling recruitment altogether was unthinkable - we owed it to all of the applicants to provide training posts in ICM; now more than ever we needed to recruit to our workforce for the future. As we simply didn’t have enough available Consultant Intensivists able to train to use the new software and then populate multiple interview sessions online and we were also concerned about putting even more pressure on our applicants to attend an online interview whilst working on surge rotas and in very challenging circumstances, we made the difficult decision to not attempt to host online interviews. We did, however, need to establish a method for verifying submitted portfolio evidence in a consistent and as fair as possible way and this had to be designed and delivered in a timely fashion. This was achieved with a lot of hard work from HEE WM staff, in conjunction with the Faculty and a reduced pool of Consultant Intensivists to act as verifiers and appeal assessors in time off from clinical work during the height of the second wave of the pandemic.


Self-assessment scoring process and appeals

The portfolio self-assessment matrix and scoring system has been in place since national ICM recruitment first began in 2012. The domains have not changed greatly over the years, and although there have been some tweaks to the scoring categories and improved guidance, this overall process and scoring system have not really changed in any significant way. The assessors responsible for verifying the evidence uploaded are all Consultant Intensivists and the majority have experience in National ICM Recruitment from previous years. They were also provided with written guidance to try to cover all of the eventualities that have cropped up in previous years and this, in combination with their previous experience, helped to ensure that portfolio self-assessment scores were verified in as consistent a way as possible. There are obviously sometimes some borderline scores, or subjective decisions to be made by the verifiers. To help in this, each assessor was buddied up with another assessor to allow them to discuss more difficult decisions and come to an agreed judgement in such cases. We simply did not have enough Consultant Intensivists available to provide every application with two assessors; if this had been the case, we would have run an online interview process as originally hoped for. For applicants who felt they had been unfairly assessed, we provided an appeals process for any applicant whose verified score was 5 marks or more lower than the score they had submitted for themselves. There had to be a cut-off of a difference of 5 marks to ensure that we were not overloaded with appeals, and can acknowledge that there will be applicants with scores of 2, 3 or 4 marks lower than they had submitted who may feel this has disadvantaged them. The system was as fair as we could make it, without making it impossible to deliver. Again, the alternative of missing an entire year of ICM recruitment was as unacceptable to us as it would have been for our applicants.


Closing statement

We are sorry that this has been such a difficult year for ICM recruitment and has resulted in so many unsuccessful applicants. This is due to an unprecedented number of candidates in combination with an unprecedented pandemic forcing us to implement a system of recruitment that none of us would have chosen if we had had the choice. The reason we have always delivered ICM National Recruitment as a face to face process in the past has been well illustrated by the problems you and we have all faced this year with delivering this as an online and remote process - it simply is not as good, or as fair, but it was the best we could do in the situation we found ourselves.

Please be aware that all of us involved in the process, from the HEE staff in the West Midlands, to the Faculty staff and the clinicians involved in designing and delivering the process, have all endured the same difficulties that you all have in terms of the stresses and strains of lockdowns, working from home, home schooling, coping with illness ourselves (and in our families) and not having the usual opportunities to relax and recuperate from what has been an extremely difficult 12 months. We recognise that many of you will have been working a greater number of more unsocial hours than ever before and dealing with sicker patients than all of us are used to; please be assured we tried our best to deliver a process of recruitment that was as fair as possible in some very difficult circumstances. It wasn’t perfect, but all applicants were judged against the same set of standards and we have made every effort to make this as fair as possible within the limits of what we were able to deliver. We all hope to be able to return to a more traditional face-to-face format next year, so that applicants in 2022 feel they have a better opportunity to gain the recognition they deserve for their achievements so that we can continue to recruit a diverse and high quality workforce in ICM for the future.


With kind regards


Dr Alison Pittard                

Dean, FICM    


Dr Jack Parry-Jones                            

FICM Careers, Recruitment & Workforce Committee Chair                         


Dr Tim Meekings

ICM Recruitment Lead