Update on IMT Curriculum

The Faculty are aware of difficulties some regions are having in implementing the Intensive Care Medicine placements required by the soon to be introduced Internal Medicine (IM) curriculum.

We are collaborating with our colleagues in the Royal Colleges of Physicians to resolve these implementation issues and I think it is important to say that the Joint Royal College of Physicians Training Board (JRCPTB) are wholly committed to implementing, in its entirety, the ICM component of the new IM curriculum which will include 10 weeks of ICU/HDU experience in a maximum of 2 blocks including the out of hours commitment.

There are regions who have highlighted to ourselves and JRCPTB that they are finding it difficult to implement the new curriculum. It was therefore agreed, that if absolutely necessary, for a transitional period of not more than 2 years, the IM trainees would be permitted to continue to contribute to the medical on call rota. It was also agreed that trainees could be released to attend an outpatient clinic each week if required. The latter will be necessary regardless of transition due to the number of clinics the IM trainees need to attend to satisfy their curricular requirements. The Faculty felt outpatient clinic attendance would not cause undue problems for the majority of ICUs.

Both FICM and JRCPTB recognise the drawbacks of the transitional on call arrangements with no out of hours commitment to ICU and both are committed to removing these transitional arrangements as soon as possible.

To that end, the Lead Deans for IM will follow up with regions who are struggling to deliver critical care to explain the compromise described above and to ensure the minimum requirement can be delivered. The IM Lead Deans will also in conjunction with relevant Postgraduate Deans try to facilitate local meetings between the Heads of School of Medicine and the ICM Regional Advisors/Training Programme Directors.

Again, just to emphasise both FICM and RCP are wholly committed to implementing the curriculum in full within a maximum of 2 years and we are currently only looking at pragmatic transitional solutions to facilitate this.

It would be very helpful if we as Intensivists could be as flexible as possible during this transition and if you feel you are experiencing insurmountable difficulties locally please let the Faculty know and we will endeavour to work with you to seek a workable solution.

The JRCPTB will seek feedback on progress at their next Heads of Schools meeting and a further meeting is planned with the General Medical Council, Health Education England, JRCPTB, CoPMED and ourselves for early December.

For ease I have copied the relevant part of the IM curriculum below.

Internal Medicine curriculum - Critical care experience requirement

Extract from the IM stage 1 curriculum

Mandatory training requirements

Critical care

It is accepted that for a trainee physician to be able to recognise, assess and care for an acutely unwell patient they need a significant experience in a critical care environment and the learning objectives for such an experience are detailed below. Discussions with trainees and the Faculty of Intensive Care Medicine would suggest that the optimum method of achieving these learning objectives would be by a 3 month attachment to an intensive care unit where the trainee is fully integrated within all aspects of the ICU team’s work including the delivery of out of hours care. Ideally this attachment should occur within the IM2 year as the trainee will have acquired an appropriate level of medical skills to maximise their learning opportunities and will be able to enter IM3 with the confidence to manage acutely unwell patients.

It is recognised that such an ideal experience may not be immediately implementable within all LEPs and therefore the curriculum mandates a 10 week minimum period of placement in critical care (ICU or HDU) settings over the 3 years in not more than two separate blocks. However, it is recommended that Schools of Medicine and Anaesthesia collaborate to implement the 3 month blocks as soon as possible.

Teaching and learning methods

Critical care

Trainees should have significant experience of critical care, preferably in a level 3 intensive care unit (ICU) or in a level 2 high dependency unit (HDU). The educational objectives of this are:

• To become better able to recognise the very sick or rapidly deteriorating patient
• To be able to work in the multi-disciplinary teams that run critical care units
• To recognise the limited resource of critical care and gain an understanding of how admission to critical care should be prioritised.
• To recognise the ceiling of care and when escalation is appropriate
• To develop enhanced procedural skills such as placement of chest drains and central venous catheters
• To understand the additional responsibilities and mechanisms of out of hours working in critical care units
• To experience the way that critical units operate in terms of human factors and technology
• To develop confidence in being involved with critical care units.

In addition to these objectives, critical care experience will facilitate acquisition of other capabilities such as communication (particular discussion with family members) and palliative care skills.

Capabilities in Practice (CiPs)

Clinical CiP 7: Delivering effective resuscitation and managing the acutely deteriorating patient

Descriptors

• Demonstrates prompt assessment of the acutely deteriorating patient, including those who are shocked or unconscious
• Demonstrates the professional requirements and legal processes associated with consent for resuscitation
• Participates effectively in decision making with regard to resuscitation decisions, including decisions not to attempt CPR, and involves patients and their families
• Demonstrates competence in carrying out resuscitation

GPCs

Domain 1: Professional values and behaviours

Domain 2: Professional skills

• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane interventions; prescribing medicines safely; using medical devices safely; infection control and communicable disease)

Domain 3: Professional knowledge

• professional requirements
• national legislation
• the health service and healthcare systems in the four countries

Domain 5: Capabilities in leadership and team working

Domain 6: Capabilities in patient safety and quality improvement

• patient safety
• quality improvement

Domain 7: Capabilities in safeguarding vulnerable

 

Dr Tom Gallacher FICM Training, Assessment and Quality Chair