This document outlines the training pathways into intensive care as they stand with the MMC changes. We will update and revise this document regularly. Doctors applying now for run through training please note that you MUST apply for a parent speciality and add in your ICM training later.

How to Train in ICM

This statement is to guide trainees who wish to pursue a career in Intensive Care Medicine (ICM) whilst the MMC changes are taking place. At present the "parent specialty + ICM" model is the only way to train in ICM. In the future it is likely that run through training in ICM alone will be possible in parallel with the current model. This document aims to 'flesh out' the previous statements to make it clear for doctors at each stage of training how they can pursue a career in ICM.

This statement is also intended for postgraduate deans to illustrate both the needs of intensive care trainees and of the specialty for flexibility in training programs to allow continued recruitment of doctors into this demanding specialty, which is at the core of delivering a first class modern health service in the acute hospital.

There are two other documents available on the IBTICM website which should be read in conjunction with this statement.

FIXED TERM SPECIALITY TRAINING APPOINTMENTS IN INTENSIVE CARE MEDICINE – GUIDANCE FOR DEANS

TRAINING IN ICM, MODERNISING MEDICAL CAREERS, ACUTE CARE COMMON STEM

For a current FY1 doctor:

FY2 training would ideally include exposure to ICM, emergency medicine or acute medicine and anaesthesia. However your FY2 rotations will NOT affect your changes of obtaining an ST1 post in anaesthesia, medicine or common stem acute care. It is recognized that a broad range of specialities can produce useful experiences to draw on later in your career. Competencies acquired during the Foundation Years cannot be assessed at that time and counted towards specialty training, they can, however, be assessed after entry to specialty training at any time.

Deans/Regional Advisors/Program Directors: the jobs found on an individual’s FY2 rotation should not be allowed to influence the selection of candidates for interview for ST1 posts.

For a current FY2 doctor applying for ST posts – You need to decide on your preferred parent specialty from:

Anaesthesia

·          Most common parent specialty in current UK practice.

·          Most DGH ICUs are still staffed predominantly if not exclusively by anaesthatists and on call consultant rotas are often combined (this situation is likely to change in the future as ICUs enlarge and anaesthetic and intensive care consultant rotas separate).

Medicine

·          Approximately 10% of UK intensivists.

·          Most from respiratory medicine backgrounds, also acute medicine (likely to increase in the future) with a few cardiology/renal physicians.

Emergency Medicine

·          Increasing numbers of emergency medicine doctors are combining EM with a career in ICM.

Surgery

·          Currently very few, but the mechanisms for training in surgery and ICM are in place.

This means applying for run through training in one of these specialties. Individual deaneries may in future offer ST posts with a combined training in ICM planned from the outset but more likely this will be by competitive application for CCT in ICM training during ST 3/5 to take posts in ST6/7.

Deaneries/Program Directors should be able to offer fixed term specialty training posts for ST trainees who need to acquire complementary specialty training later in their careers in order to pursue ICM training. “Time Out” from ST training to complete this complementary training will be required and should be supported by deans (see below)

Acute Care Common Stem (ACCS) This training option has been developed to suit the development of appropriate medical staff in emergency medicine, intensive care medicine and acute medicine. This will comprise the first 2 years of ST training in emergency medicine and acute medicine, but for trainees wishing to do anaesthesia; entry into anaesthetics will be at ST2. For the would be intensivist it is ideal in that it provides a broad foundation and satisfies the complementary training needs at an early stage.

Whilst applications for ACCS post will be ST training in a chosen specialty (emergency medicine, anaesthetics, medicine) there may be trainees who, during completion of their ST1 and ST2 rotations decide they would like to change specialty if possible (e.g. from emergency medicine to acute medicine or anesthesia). In order to do this they will need to resign from their current specialty and apply via competitive interview for an ST3 post in the new specialty (or ST2 in the case of anaesthesia) however it is hoped that the deans will be positive in assisting trainees wishing to do so and there should be the expectation that there will be vacancies developing at ST3 in these specialties as trainees change direction. There may also be individuals who decide to change direction during their later training years; they will also have to apply to ST3 in the new specialty.

Deans: please do all that is possible to ensure that ST2 ACCS trainees who wish to apply at competitive interview for transfer to a new specialty at ST3 after ACCS are assisted and encouraged, by providing as much information as possible about any upcoming vacancies at ST3.

A further option is to apply for a Fixed Term Specialty Training Appointment (FTSTA) in intensive care medicine. Some candidates may decide to apply for a FTSTA in a specialty first and follow this with one in intensive care before applying for ST training at ST2 or ST3.

Deans: trainees who have completed a FTSA solely in ICM should be eligible for ACCS training at ST1 level as they clearly will not have completed the other three specialties. It may be possible to provide them with alternative experience rather than a further 6 months ICM at this level.

For a current SHO wishing to pursue a career in ICM

This will depend on your individual experience so ar. If you have extensive experience in a specialty e.g. medicine and wish to continue to pursue a medical career and add in ICM training then you should apply for training in the medical specialty of your choice3 and the apply in ST4/5 for a training opportunity in ICM when one is advertised. If you are successful complementary training in missing specialties needs to be built into the remainder of your training program.

Deans: When trainees are appointed to a joint CCT in ICM Training Committees in the specialty of primary appointment must ensure that timely training opportunities in ICM and lacking complementary specialties are integrated into the trainee’s program. This will require careful negotiation with the TPDs of all the programs concerned. Some of these trainees will have been appointed as late as ST5 and will need to acquire competences normally acquired in earlier years.

For a current SHO wishing to pursue a career in ICM combined with a different specialty from his or her experience

The obvious example is the SHO who has completed a couple of years of medicine and now wishes to pursue a career in anaesthesia and ICM (this may have been the long term plan). You should apply d=for ST1 posts in the specialty you wish to pursue long term (in the example – anaesthesia). Please note that you will be eligible for ST1 applications provided that you do NOT have extensive experience in the specialty for which you are applying (e.g. anaesthesia). If you DO have experience in the specialty you wish to pursue in the long term then you should be applying at ST2 or ST3 level, please advise your local deans and tutors or consult MMC website for advice.

Deans/Program Directors/Regional Advisors: some SHOs have been told that they are “not eligible” to apply for STI posts, which is clearly not the case if the ST1 post they wish to apply for is in a specialty in which they do not have more than 12 months experience. Many trainees intending to follow a career in ICM will have been deliberately acquiring broad experience prior to applying for specialty training in the old system, wherever appropriate, as it is their experience at the middle grade level that will ensure the success of and smooth transition to the new MMC program.

For current SpRs wishing to train in ICM

The application process for CCT training in ICM will change very little. You should apply for ICM training by competitive interview during the first 3 years of registrar training when opportunities arise. If you need to acquire complementary specialty training this can be achieved by a FTSTA appointment. You will need to find these posts by discussion with your local Board Tutors and Regional Advisors and discussion with program directors in complementary specialties. You must then negotiate with you deanery for time out of program to take up these posts.

Deans: please allow current SpRs “time out” (off program experience) to complete ICM and complementary specialty posts either before they apply for ICM specialty training posts or after being appointed before they begin their Step 2 training in ICM. Please note that some ICM CCT programs do not allow application from trainees who have not yet completed complementary training, therefore trainees will need to be allowed to complete this prior to application for ICM training positions.

Please note that this document will be updated at regular intervals as changes occur in the way MMC is implemented. Many of the changes have been devolved to local solutions and the local Dean ultimately is responsible for the training that is offered within their region. ICM training by its parent specialty nature requires negotiation and discussion in order to tailor a program to individual trainee’s requirements.