The Current Organisation of ITU training
Intensive Care Medicine (ICM) is not currently a separate medical specialty in the UK. Trainees wishing to specialise in intensive care must do so in addition to the training in their parent specialty. This parent specialty is most commonly anaesthesia, but can also be emergency medicine, internal medicine, with or without a medical subspecialty, or surgery (acute surgical specialties). On successfully completing both the training in the parent specialty and ICM, the successful trainee will be awarded a ‘Dual CCT’.
Given that ICM is not currently a separate medical specialty, it does not currently have its own Royal College. At present ICM training is organised by The Intercollegiate Board for Training in Intensive Care Medicine (IBTICM), which includes representatives of the Royal Colleges of Anaesthetists, Physicians, Surgeons and Emergency Medicine.
In May 2010, The Faculty of Intensive Care Medicine (FICM) was created, with the aim of developing ICM as a specialty. When the FICM is up and running, the IBTICM will morph into the Training and Examinations Committee of the new Faculty.
The Current Structure of ICM Training
For a general background to training in the UK and an explanation of the abbreviations for the various training grades, please see ‘Postgraduate training in the UK’
The FICM website details the current structure of ICM training in the UK. With time, with the development of the FICM, this information will be contained within its website. At present ICM training has a series of steps:
- Basic training: 3 months of basic ST/SHO/CT level training in ICM
- Complementary Specialty training: In addition to time spent working in ICM, trainees are expected to have undertaken a minimum period of 6 months of anaesthesia and/or 6 months of acute general medicine. Both these periods of training are at ST/SHO/CT level. The duration and requirement for complementary training is entirely dependent upon the parent specialty of the trainee: 6 months acute general medicine for an anaesthetist, 6 months anaesthesia for a physician (with an additional 3 months general medicine for emergency medicine trainees), both for a trainee surgeon
- Step 1/Intermediate training: 6 months of general adult ICM as a SpR/StR, undertaken in blocks of no less than 3 months. Such training must be undertaken in ICUs recognised for training purposes by the FICM. The FICM does not keep a formal record of all these units; each region keeps its own list!
- Step 2/Advanced training: A further 12 further months of SpR/StR training in ICM, undertaken as a single block within FICM recognised units. Step 2 training must be completed within the final 2 years of the trainee’s specialty training programme. Up to 50% may be in specialised ICM, and up to 50% of Advanced training may be undertaken in an overseas post
The FICM has a very comprehensive list of skills and knowledge expected at each level of training: http://www.ficm.ac.uk/_assets/pdf/the_cct/cct%20in%20intensive%20care%20medicine%2 0-%20part%20iii%20syllabus%20.pdf
The Future of ICM training
ICM training in the UK is currently in a transition. The Postgraduate Medical Education & Training Board (PMETB), now merged with the General Medical Council (GMC), has recently decided that the current arrangement for ICM training to operate as a joint CCT programme, with a parent specialty, is no longer acceptable. Instead, there is now a requirement for ICM to have its own single standalone CCT programme. The FICM is currently preparing a standalone ICM CCT programme for submission to the GMC in 2011.
The IBTICM released a statement regarding the future of ICM training in May 2010: http://www.ibticm.org/_assets/pdf/latest_news/future%20of%20icm%20cct%20statement %20(may%2010).pdf
Where Australian ICM trainees would fit into the UK ICM system
Given that there is no such thing, at present at least, of an ‘ITU only’ trainee, it is perhaps difficult to equate Australian ICM training with the UK system. Basic ICM training in the UK is 3 months of ICM and would occur early in a trainees specialty training. Consequently, UK basic ICM training would occur at a resident level in Australia. Step 1/Intermediate ICM training in the UK would usually occurs at the junior registrar level in Australia. An intermediate ICM trainee in the UK would complete a further 6 months in ITU and would have done a few years of specialty training. Step 2/Advanced ICM training occurs in the last two years of specialty training in the UK and so would be equivalent to a Senior Registrar or Fellow role in Australia.
Faculty of Intensive Care Medicine: http://www.ficm.ac.uk/
Intensive Care Society, has a useful trainees section: http://www.ics.ac.uk/