Trainees’ Guide to ICM in Thames Valley
Introduction for all trainees starting in 2019
We aim to give you all the information, that you would normally receive in an induction pack, below. All information regarding training units, contacts, ARCP requirements are found on this website, the links will be highlighted.
On this page we aim to help you understand the training programme and what is required to be successful at ARCP. Please read through the page carefully.
What will my training programme look like?
How will my progress be assessed?
If you need to contact anyone regarding your training programme, either TPD, RA or trainee representatives, use the WHO’s WHO page for details.
To contact the college tutor for your unit, their details can be found on the UNIT PAGES.
The faculty of Intensive Care Medicine requires all trainees to register with them. If you have not done so already please do so as soon as possible, it is your responsibility to ensure you are registered as an ICM CCT Trainee. If you were previously registered as an affiliate trainee, you neet to complete the CCT trainee paperwork now.
Forms can be found here: CCT TRAINEE FORM
The TPD and Regional Advisor (RA) have to countersign your form before you can submit it. Both the TPD and RA will sign these forms electronically. The registration form requires details of previous training in ICM as well as your proposed ST rotation. Remember to fill in the details of time spent in ICM as part of your core training programmes, as this is part of the information FICM will use to assess completion of Stage 1 training.
You will need to clarify the details of your proposed ST training programme with the TPD if you haven’t done so already, please do this before completing the forms.
FICM will provide access to the e-portfolio after you have registered, so it is in your interest to get this done as soon as possible after appointment.
2. Educational Supervisors
Each trainee in the training programme must have an Educational Supervisor (ES). Your ES exists to provide advice and a point of contact on training issues/exams, and they must write an Educational Supervisor’s Structured Report (ESSR) at the end of each and every year of your training. Your ES should be an Intensive Care Medicine consultant even when you are gaining experience in other specialities, in order that they can give appropriate advice regarding your intended path of training.
We have found that on the whole it is preferable to keep the same ICM ES throughout your ICM training. If this doesn’t work for you for whatever reason please get in touch with the TPD who can help. You will also have a clinical supervisor (CS) in placements outside of ICM and when you are not in the hospital where you ES works. You need to have regular educational meetings with your ES and this is particularly important in the weeks leading up to ARCP.
You should have a named ES within the first 2 weeks of commencing each placement. If you are having problems with this, contact the TPD.
3. Clinical supervisors
A CS is the consultant who is named to supervise you during a particular specialty placement and therefore will be a consultant from that specialty. Their role is to assist you in completing assessments for that specialty block, provide advice relating to the placement if needed, and also conduct your educational meetings during that placement.
You should have a named CS within the first 2 weeks of commencing each placement. If you are having problems with this, contact the Faculty Tutor or the TPD. You need to have regular educational meetings with your CS and the information recorded in your e-portfolio by your CS helps your ES when they come to write your ESSR at the end of the year.
Your ES can be your CS when you are working in their department, hence you will not need a CS.
Please be aware that it is your responsibility to arrange educational meetings with your supervisors. If you are struggling to get your appraisal times agreed with your supervisors then please contact the TPD for help.
Trainees should complete an educational agreement with their CS/ES within two weeks of the start of each placement. This should clearly establish the training goals of the placement and forms part of the basis of subsequent review at meetings with your ES and CS.
You need to undergo regular appraisal and assessment during ICM training. Progression from one stage of training to the next is dependent on successful assessment. You need to have an initial, mid-point and final appraisal as a minimum for each placement. During these meetings you will review your portfolio, assess your progress through the curriculum and update your personal development plan.
In addition to the formal appraisals, at the end of each year of training your Educational Supervisor will be required to complete an ESSR, which is a summary of your activity and progress during the previous 12 months.
Every ICM trainee must maintain an e-portfolio. As highlighted earlier you need to be registered with FICM to have access to this e-portfolio. With access, you can record both your educational agreement and meetings with supervisors and in addition you can begin to have competencies signed off. It is your responsibility to make sure that you are registered and have access to the portfolio. Tell the TPD if you have difficulties registering or securing e-Portfolio access.
The FICM eportfolio is an NHS eportfolio and is therefore broadly similar to those used by the Foundation Programme, Royal College of Physicians and Royal College of Emergency Medicine. If you already have an NHS eportfolio account, tell the FICM team so they can add ICM access to your existing account. Your ES should be registered with FICM and should have supervisor’s access – if they don’t have, they should contact the local FICM Tutor or the RA for help with registration. Individual assessors who sign off competencies do not need to be registered, but can be sent tickets containing links to the assessment(s) you wish them to complete. Unfortunately, the various speciality portfolios do not link to each other, so if you are dual training then you will need to maintain a separate portfolio of evidence for each speciality. Bear in mind that many workplace based assessments you wish to complete may be relevant to both specialities, so make sure you capture a record in both speciality portfolios.
As you fulfil the curriculum requirements you may find that some evidence you wish to include doesn’t seem to fit nicely within the assessment section of the eportfolio. If this occurs, you can upload evidence into the “personal library” or “certificates and exams” section of your profile.
5. What will my training programme look like?
Full details of the structure of single and dual speciality ICM training programmes are contained within the FICM curriculum document Part 1 (Handbook) and are available for download at: https://www.ficm.ac.uk/trainingcurricula-and-assessment/curriculum
On the FICM website there are sample grids of what representative training programmes might look like, but your specific programme will be worked out locally and will be unique to you.
In summary, standalone ICM training takes a minimum of 7 years and is divided into 3 stages:
(i) Stage 1: Minimum 4 years: core training and ST3+4
(ii) Stage 2: ST5+6
(iii) Stage 3: ST7
You have entered this higher specialty training programme after the completion of core training in ACCS, medicine or anaesthesia and are now starting your ST3/4 years in order to complete ICM Stage 1 training. The structure and duration of the representative ST3/4 years will depend on the experience you gained during core training and whether or not you are dual training.
If you are dual training, you are working towards 2 separate CCTs, but the training programme you embark on to obtain these CCTs will be adjusted to take common competencies into account. Your TPD will work out the specific details of your programme with you when you are appointed, so don’t worry if it doesn’t look exactly like the typical examples shown in the curriculum documents.
ICM Stage 2 training is designed to give experience in a particular area of ICM. If you are dual training in anaesthesia, this ST5 training year is counted towards both specialties. This stage of training also includes a special skills year – if you are training solely in ICM this will be a subspecialty area of interest, but if you are dual training, this year is spent in higher training in your other specialty, because that is the special skill you bring to ICM.
ICM Stage 3 training is an advanced year of ICM experience, during which you will gain higher-level management and administrative skills in additional to consolidation of your clinical skills. If you are dual training, you may then have further training to complete your second specialty before your CCTs are awarded at the same time.
6. Dual Training
Many trainees wish to train in two specialities, rather than just intensive care medicine. This is achieved through application to two separate programmes in sequential years: although this may change in the future. Some of you may already be in dual programmes, while others may wish to apply for a second speciality in the next 12 months. If you are going to apply for a second speciality, it must be in HETV. Let the two TPDs know as soon as you decide you are interested, because they will then have to work out the specifics of what a dual training programme would look like if you were successfully appointed to the second post.
There is plenty of information about dual training programmes on the FICM website with representative programmes for those wishing to dual accredit with anaesthesia, acute medicine, respiratory medicine, renal medicine or emergency medicine.
Remember that your TPDs will work out your specific training programme with you, so it may not be identical to the examples you see on the Faculty website, but it will meet all the CCT requirements of both specialities.
7. Out of Programme Experience (OOPE)
The ICM Training Committee always aims to support your further development whenever possible, but it is up to you to show how an OOPE would be relevant to your training programme and would enhance the skills you bring to the ICM community; please don’t assume approval is automatic.
OOPE can be considered only after you have completed Stage 1 training. The GMC has quite specific requirements regarding prospective approval of OOPE time, with 6 months of notice to each speciality in which you are training. Time can be taken as an OOPE that does not count towards training time, or as out of programme experience for training (OOPT) or for research (OOPR) which does count.
You will need to map the OOPT / OOPR to competencies in the ICM CCT programme if you wish the OOP time to count towards your CCT. In addition, there is a limit to the amount of out of programme time which can count towards training – see the curriculum documents for more detailed information. Talk to your ES/TPD/RA about the possibilities as soon as you see something you are interested in.
8. How will my progress be assessed?
If you look at the assessment document within the curriculum https://www.ficm.ac.uk/trainingcurricula-and-assessment/curriculum you will notice that you have to cover the entire curriculum at each stage of training – a process called spiral learning. Early in your training you may work under direct supervision (level 1), progressing to the point at which you require little guidance (level 3) or no guidance (level 4) by the time you finish ICM Stage 3 training.
For example, after core training, trainees coming from CMT will not be expected to have any experience in the management of the trauma patient, but those coming from CAT and ACCS should already be able to work to level 1 (direct supervision). By the end of Stage 1 training (ST3/4), all trainees should be competent to work at level 2 (able to deal with straightforward matters).
Another example: after core training, ACCS trainees will have had training in the management of mass casualties to level 1. Anaesthetic and medical trainees will not have this expertise, so during their remaining Stage 1 training (ST3/4) they will need to acquire competence to level 1. Those coming from ACCS should demonstrate that they have retained their level 1 competence.
Finally, no core trainees are expected to have competence in the management of burns, but by the end of Stage 1 training, all trainees should be competent to level 1.
During each stage of training you need to work through each competence in the curriculum and provide evidence to satisfy your ES that you are competent to the required level. Your ES will then record this in your portfolio, turning the red dot beside each competence to green.
At the start of each placement you need to meet your ES to agree which curriculum areas you will cover during that training block and what type of evidence you will bring to your subsequent ES meetings. You should arrive prepared, knowing your curriculum and the level to which you will be aspiring to work.
Please note that in keeping all other specialities the curriculum is currently under review in line with GMC priorities – the new curriculum in not likely to be released before 2021. It is anticipated that there will be a substantial reduction in the number of domains to be covered during each stage.
What type of evidence should I provide?
You should use a combination of various different forms of evidence as shown on the grid on the next page. Your ES will work through this grid with you as an ARCP checklist (see link for version 1.9 2019 ARCP checklist) to ensure that you give the ARCP panel everything they need to sign off your year of training. The checklist lists the minimum number of items of evidence that should be collected in each category, but the most successful trainees often gather well in excess of the minimum.
Who can sign my WPBA?
Senior trainees as well as consultants can sign WPBAs. It is ideal to have as many completed by a consultant as possible, but the training committee knows that you often work directly with more senior trainees and specialty doctors. For information on which specific WPBA a consultant must complete, please talk to the local tutor for the specialty and hospital in which you are working. They will tell you which seniors within your department can sign your forms or etickets.
Annual Review of Competency Progression
The Annual Review of Competency Progression (ARCP) is the process whereby all assessments of a trainee’s knowledge, skills and attitudes throughout the year are brought together for review at Deanery level. Ultimately, the “ARCP outcome” is a Yes/No decision on whether or not you are progressing well enough to move on to your next year of training.
All up to date ARCP information, dates and times can be found HERE.
You will be invited to one ARCP once a year (even if out-of-programme for any reason). Usually the main ARCP period is in June-July. You will be given at least 6 weeks’ notice of the date and you must make sure all your evidence is submitted by the deadline of 2 weeks before the ARCP. You will need to complete the ARCP checklist for ICM every year even if you may have been in for example, acute medicine.
Why does the ARCP matter?
It is not just an important milestone in your training, providing evidence that you are progressing satisfactorily with your career. The ARCP also has a very important role in facilitating your revalidation with the GMC. You must therefore take the process seriously and provide all documentation on time.
Preparing for your ARCP
It is imperative that you meet with your ES several weeks prior to the ARCP date to complete your end of attachment appraisal and ESSR. The ESSR is the only means by which your ES can give the ARCP panel their professional opinion on your progress. Your ES will also make a recommendation as to the outcome the ARCP should award. Failure to complete the ESSR prior to the ARCP will mean you automatically get an outcome 5 (insufficient evidence supplied). It is your responsibility to ensure you meet with your ES to do this, not the other way round.
Every year you will be asked by the Deanery to complete a Form R and a wider scope of practice form and failure to submit these to the Deanery at least 2 weeks prior to your ARCP date will result in an automatic outcome 5 (insufficient evidence supplied) at ARCP.
What is the ICM ARCP like?
The ARCP panel is composed of consultant representatives from the training departments, the TPD, a lay member, a deanery programme manager and usually a deanery representative from an unrelated speciality. The panel reviews your portfolio of evidence and decides on your ARCP outcome.
The outcome of your ARCP will have been decided by the panel before you enter the room. They will then invite you into the room to tell you the outcome and have a brief chat about the previous year as well as the coming year. The intention is that the outcome you are given by the ARCP panel should not come as a surprise. Through your meetings with your ES you should have a clear idea of what outcome you are likely to get, because you should be well aware of how you are progressing with your training.
The ARCP panel will give you one of six outcomes:
Outcome 1: Satisfactory progress confirmed, can move onto next stage of training.
Outcome 2: Some additional competences are needed (e.g. more WPBA) but training does not need to be extended. With this outcome you will be given a time limit by which you need to have provided the additional evidence that you have completed the outstanding competences. If you are unable to do this within the time-frame given then training may need to be extended.
Outcome 3: The panel think you cannot progress further without additional training time. The panel will decide how long the extension should be.
Outcome 4: You are released from the training programme before completing your training. This will usually be due to repeated failure to progress.
Outcome 5: You have not provided the panel with sufficient evidence for them to be able to make a decision. This includes failure to complete an ESSR, or form R. With a little preparation, this outcome is largely avoidable.
Outcome 6: This is the final sign-off at the end of training, and indicates you have satisfactorily completed all the requirements of the ICM CCT programme.