Intensive Care Medicine

 

Welcome to the Intensive Care Medicine home page for ACCS.

During the first two years of ACCS training, trainees usually spend 6 months in ICM. During this time you should follow the CCT in Intensive Care Medicine as defined by the Faculty of Intensive Care Medicine.

Intensive Care Medicine (ICM), also referred to as critical care medicine, is that body of specialist knowledge and practice concerned with the treatment of patients, with, at risk of, or recovering from potentially life-threatening failure of one or more of the body’s organ systems. It includes the provision of organ system support, the investigation, diagnosis, and treatment of acute illness, systems management and patient safety, ethics, end-of-life care, and the support of families.

Intensive Care Medicine was approved as a single specialty programme in 2011, with the first trainees appointed in 2012.  The Joint CCT in Intensive Care Medicine, which preceded the CCT, is no longer recruited to though there are a number of existing trainees in the system who remain on this programme.

It is important to remember to:

  • Follow the appropriate competencies within the ICM CCT.
  • Complete a selection of work based assessments.
  • Maintain your portfolio of evidence.
  • Attend any specific tutorials and education sessions as required by your deanery.

Further information on the curriculum (competencies and assessment systems) can be found on the FICM website.

 

Curriculum


Background to the curriculum
The development of the syllabus for the CCT in ICM has drawn extensively on the CoBaTrICE syllabus created under the auspices of the European Society of Intensive Care Medicine. Using consensus techniques core competencies were generated which are internationally applicable but still able to accommodate local requirements. This provided the foundation upon which this competency based training programme for Intensive Care Medicine was built.

The training programme is based on the concept of spiral learning which ensures that the basic principles learnt and understood are repeated, expanded and further elucidated as time in training progresses; this also applies to the acquisition of skills, attitudes and behaviours. The outcome is such that mastery of the specialty to the level required to commence independent practice in a specific post is achieved by the end of training as knowledge, skills, attitudes and behaviours metaphorically spiral upwards.

Stages of the curriculum
The ICM CCT is divided into 3 Stages of which core training comprises a part of Stage 1.

Stage 1 (CT1-ST4) training consists of an initial four year block of training. The first years will  be spent in Core Anaesthetic (CT1-CT2), Core Medical (CT1-CT2) or ACCS (CT1-CT3) programmes. Competitive entry to ST3 will occur. ST3 and ST4 are intended to consolidate the trainee’s knowledge and skills in general diagnosis and patient management and enable trainees who enter from a variety of core programmes to achieve the designated competency levels by the end of ST4.  Trainees on the ICM CCT who have undergone ACCS and have 3 years of training competencies acquired may only need to undertake one year to complete Stage 1 and will then progress to ST5.  This will be considered on a case by case basis by your local trainers.  Stage 1 contains minimum training times of 12 months each in anaesthesia, medicine and ICM across the minimum four year training Stage.

As 6 months of ICM will only comprise part of the experience required for completion of Stage 1, there is no one piece of sign-off documentation purely for ICM during core training.  Sign-off is therefore undertaken with local assessment and the ARCP.

 

Assessments


Understanding ICM assessments
The purpose of the ICM workplace based assessments is not merely to tick off each individual competence but to provide a series of snapshots of work, from the general features of which it can be inferred whether the trainee is making the necessary progress, not only in the specific work observed, but in related areas of the application of knowledge and skill. The number of observations of work required will not be fixed but will depend on the individual trainee’s performance. The Faculty’s aim is always to maintain training standards and quality without developing undue ‘assessment burden’ for trainers and trainees.

As a minimum standard, trainees must have at least one piece of satisfactory assessment evidence for every competency required for sign-off at a particular Stage of training, though it is expected that trainees will ultimately have multiple assessment mapping to multiple competencies. For some sections of the curriculum (i.e. Practical Procedures) it is expected that more than one assessment will be required, at the discretion of local trainers. Where a trainee performs unsatisfactorily more assessments will of course be needed.

Each piece of evidence can potentially be used to support multiple competencies. A single patient encounter involving a history, examination, differential diagnosis and construction and implementation of a management plan could assess many of the competencies together.

Minimum number of assessments
Whilst the key principle is that trainees must have at least one satisfactory piece of evidence for each competency requiring sign-off, a minimum of one of each of the listed assessment types – or the School mandated minimum, whichever is greater – should be completed for each 3 month ICM block or rotation, i.e.

WPBA per three month block/rotation
1 x DOPS
1 x ICM-CEX
1 x CBD
1 x ACAT

Progression grid
As the ICM CCT both operates on a system of spiral learning and accepts doctors from multiple core programmes, there is a progression grid included in Part II of the CCT in ICM.

The grid demonstrates the progression of competency expected of trainees in each curriculum domain throughout the Stages of ICM training, including the different level of competency expected from ACCS (which will include the entirety of that experience through ICM, anaesthetics, medicine and emergency medicine).

The progression grid is available on the FICM website.