The requirements for advanced training in paediatric intensive care are very similar to the general fellowship. For a full description, please see the following CICM document: http://www.cicm.org.au/trainprogram.php
The Training Program is split into
- Training requirements (basic and advanced training)
- Examination requirements
- Project requirements
- Success at either the CICM primary examination, or an approved primary examination. This must be successfully undertaken before starting advanced training.
- Success at the College’s Fellowship Examination in Paediatric Intensive Care (after at least one core year of Paediatric Intensive Care training in advanced training).
- Successful completion of the formal project
- Successful completion of the ADAPT workshop
The paediatric objectives of training have just been published, and are available on the CICM website: http://www.cicm.org.au/cmsfiles/Paediatric_Objectives_of_Training.pdf
For those at the very start of your training, it is time well spent to consider your personal and professional goals at the end of training. Whilst it is possible to specialise only in paediatric intensive care, combining this with another area can be beneficial. Combining PICU training with anaesthesia can broaden the range of specialist jobs available to you, and in some situations, reduce the amount of after hours work. Whilst there are some outstanding examples of intensivists who are actively working in General Paediatrics as well as intensive care, a consultant role combining both these areas can be challenging to arrange at the end of your training.
Both the college and potential employers encourage trainees to work in different units during their training, and preferably also in different countries, to develop a broad perspective on paediatric intensive care. As a rule, trainees will be expected to spend at least one year in another centre.
For many trainees who are non anaesthetists, obtaining an anaesthetic position can be challenging. This is becoming easier as positions are being created for ICU trainees in some centres. Alternatives include being prepared to move to a smaller centre for the anaesthetic term, or applying for anaesthetic SHO training positions. In all cases, apply early, as arranging this part of training can take time.
It is ideal to undertake the fellowship examination whilst working in paediatric intensive care. It is an intensely practical exam, and being at the coal face on a daily basis makes it easier to organise practice cases for the clinical examination, and also makes you look like you do this every day (which you do!).
In practice it is uncommon in paediatric intensive care for someone to undertake only 36 months of advanced training and then start working as a specialist. It is more common to do several / a number of years of fellowship in different units to gain further experience / await a consultant position to become available.
Paediatric intensive care training is commonly combined with training in
- Physician training
- Emergency medicine
It can also be combined with general intensive care training, and surgery.
It can be a challenge to interleave different training programs in a way which does not significantly increase the number of years required to complete both programs. This is particularly true when changing hospitals (units sometimes wish a new fellow to work as a registrar for a period to get to know a unit prior to undertaking a fellow role), or countries. This needs planning well in advance.
Advanced training for the RACP has changed for trainees registered in 2007 or later, and will change again this year; and training requirements for the CICM changed for those registered after the 1st Jan 2011, so trainees are working under many different combinations of training requirements. The training requirements also differ depending on whether you are registered as an Australian or New Zealand trainee. This is independent of where you are working. This, in combination with the small number of paediatric intensive care trainees, makes it quite complicated. The details of RACP training can be found on the RACP website, however you need to have registered to view the page : http://www.racp.edu.au/page/educational-and-professional-development/advanced-training/advanced-training-requirements
To work as a General Paediatrician in New Zealand, it is necessary to complete the RACP specialisation under the SAC of General Paediatrics (rather than a generic paediatrics fellowship).
It requires a great deal of organisation to arrange all the pieces necessary to complete both fellowships in a manner that does not add significant time. Due to the complexity of the different training requirements, it is not possible to give one definitive pathway. It is however critically important to meet with your physician supervisor of training regularly to ensure you are fulfilling all of the requirements prior to organising advanced training, in particularly prior to commencing the final year. This is particularly important if you undertake a long period of paediatric intensive care, and may not have the general paediatric requirements at the forefront of your mind.
The order in which the segments of training time are completed in advanced training is not usually important to the college, however it is difficult to go back to being a ward registrar after working as a paediatric ICU fellow. I would recommend either completing all the mandatory requirements for the RACP prior to undertaking the paediatric intensive care senior registrar year, or alternatively organising a fellow position to complete the remainder of RACP training after completing CICM training.
It is possible to cross credit a large amount of the time in intensive care to RACP training. However, depending on which training rules your training is governed by, the RACP may also require time working in
- A rural rotation
- A community or psychosocial rotation
- Child protection
- Core general paediatrics or a subspeciality (some of which can be credited to ICU if you have not accredited time in basic training)
- 100 new outpatients (which can be a challenge if the majority of time is spent in ICU)
Depending on when you started your RACP training, you will be required to complete either one large or two smaller research projects. The requirements are clearly outlined on the RACP website under advanced training. Technically, one project must be successfully completed prior to undertaking the final year of advanced training. One project (a significant research project which fulfils the requirements of both colleges) can be submitted to both colleges.
The RACP examination qualifies as a primary examination for the CICM. Advanced training in intensive care may only be commenced after the examination has been successfully completed (unlike in the RACP). The Paediatric Intensive Care CICM examination must also be completed.
Anaesthesia training is of 5 years duration and is divided into basic and advanced training. Training can be entered after completion of the PGY1. Anaesthesia has a very well defined training structure, and details of the training program are clearly described on the college website http://www.anzca.edu.au/trainees/atp/.
Success in the anaesthesia part one examination allows entry into Intensive Care Advanced training.
Anaesthesia trainees also need to complete a formal project. This project, if fulfilling the criteria of both colleges, could be submitted to and fulfil the project requirements for both colleges.
Advanced training in anaesthesia is of three years duration, and can only be commenced after successful completion of the anaesthesia part one examination. Paediatric anaesthesia fellowships sometimes involve a proportion of time (e.g. six months) in paediatric intensive care, and six months working in paediatric anaesthesia.
Trainees who have a dual fellowship in anaesthesia / paediatric anaesthesia and paediatric intensive care often find themselves more easily employable than pure paediatric intensive care trainees / dual trainees with general paediatrics, as they are not restricted to 100% work in the ICU. Variation in work environment and stressors may also lead to less burnout.
Paediatric intensive care training can be combined with either adult or paediatric emergency medicine. Entry into advanced training can be via either the RACP exam, or the emergency medicine part one.