Intensive Care Medicine National Recruitment 2013

Tom GallacherNational Recruitment Lead

Faculty of Intensive Care Medicine

Background1952 Polio epidemics; ventilator units1960s General ‘intensive therapy’ and respiratory support units1970s ICS established (SICS & WICS 1991)1988 Joint Accreditation Committee for Training in Intensive Therapy [JACIT]

1992 Intercollegiate Committee for ICM1994 ICNARC established, 400K 2-yr grant 1996 Intercollegiate Board for Training in ICM (AoMRCs)1999 June 7th Min Health authorises change to Specialist Medical Order, ICM a Speciality.2000 Comprehensive Critical Care, Critical Care Networks2001 Feb Competency-based training programme in ICM approved2005 DoH Advisor in Crit Care (end 2011); Stakeholder Forum

2009 Seven RCs endorse proposal to establish intercollegiate Faculty of ICM.

2010 GMC rejects Joint-CCT ICM training programme, requires single CCT

2010, Nov Foundation Board of the FICM

2011 Mar 1st GMC review panel conditionally approves ICM single CCT programme2012 Aug 1st New ICM programme implemented; ICM a primary speciality

  

THE CCST IN INTENSIVE CARE MEDICINE

  

Competency-BasedTraining and Assessment

 

 PART I

 A reference manual for trainees

and trainers   

   Revisions and comments:This version of the training programme is valid for 2001. It will be reviewed annually. Comments on the training programme are welcome, and should be directed to the chair of the ICBTICM

ICM: the first speciality to produce a comprehensive competency-based training programme: Feb 2001

The Joint-CCT in ICM

• Joint = [ICM + Parent speciality]• Maximum duration: 33 months• Administratively, this made ICM a multiple

subspeciality

Submission of Joint CCT ICM programme to PMETB

The solution

Entry from CAT, ACCS or CMT

Why plurality?

– ICM Primary specialty

– Founding principle in the curriculum

– Selects the best doctors for Intensive Care Medicine

– Permits future changes to the shape of the workforce

Intensive Care Medicine Stand Alone CCT

Why not appoint to both primary specialties in the same recruitment round?

– 5 partner specialties and 14 Deaneries

– UK Offers system is designed to prevent trainees holding more than 1 offer

– Desirable to limit dual programmes to a single UoA

– Trainees have time to consider their career choices

Why not have pre-defined dual programmes (“badging”)?

- Primary specialties and their CCT curricula are independent

- Programmes are dual since they contain competencies common to both specialties curricula

- Appointment to a primary specialty is according to that specialty’s selection criteria

Why not have pre-defined dual programmes (“badging”)?

- Specialty selection processes must select the best candidates for that specialty only

- Impossible to rank candidates if we try to combine scores from different selection processes

- Smaller specialties may have no access to ICM training due to lack of availability of a pre-

defined programme

- ICM CCT output would be defined by service needs during training years

Worked example- pre-defined ICM/anaesthesia dual programme

- Applicants from ICM or from anaesthesia ST3

- ICM trainees have anaesthesia interview and anaesthesia trainees have ICM interview

- Each specialty selection process will have a highest ranked candidate

- Which trainee do we appoint?

- Specialty selection processes are not comparable since their criteria, format and content differ – apples and oranges

- A second “decider” interview is not fair since appointment to the second primary specialty would not be according to the criteria used to select all other successful trainees

Dual CCT’s Programme

ICM and one of five partner specialties

– Emergency medicine

– Acute medicine

– Anaesthesia

– Respiratory medicine

– Renal medicineCommon competencies mean duration of the dual programme is not the sum of the individual competencies

Competencies gained in one programme can count towards the other

It is the programme that is dual not the CCT’s – these are separate and independent

Dual CCT’s Programme

– Need to be successfully appointed to a programme in ICM and one of the partner specialties in different recruitment episodes

– Can only apply for a second programmes in same Deanery

– No seniority limit for application to dual programmes in 2013

– If commence 2nd programme within 18 months of first then dual CCT’s

– If greater than 18 months delay then CESR (CP) for second programme

GMC Conditional approval of the single CCT programme in ICM, March 8th 2011

GMC Conditional approval of the single CCT programme in ICM, March 8th 2011

• ICM now a primary speciality, like any other primary speciality

• Unlike any other primary speciality, we wished to retain strong links with multiple partner specialities (previously ‘parent’ specialities)

• This required clarification of the mechanisms for appointment to, and of the conduct of, Dual CCTs, taking into account equity and equal opportunity of access for trainees from these partner specialities

Key GMC condition: Equity and equal opportunity of access

Implication: Plurality of access • ICM training posts should be accessible by the best

candidates regardless of partner speciality• Hypothecation / badging of ICM posts not possible

‒ not equitable‒ national recruitment process cannot accommodate

72 new posts for E&W:• 127 applications• 124 met essential criteria• 114 attended for interview• 86 candidates considered appointable• 52 offered & accepted posts (quality ranking)

52 appointees:Source n (%): • ACCS: 23 (44%)• CMT: 15 (29%)• CAT: 14 (27%) 111/114 candidates feedback:Intended Destination n(%): • Single CCT ICM: 5 (4.5%)• Dual CCTs: 84 (75.5%)• No response: 22 (20%)

2012 ICM recruitment outcomes

85 candidates had also applied to another speciality:

• Anaesthesia: 54 (63%)• Resp Med: 10

(11.7%)• Acute Medicine 9 (10.5%)• Emergency medicine 5

(5.8%)• Ologies: 7

Summary for COPMeDFebruary 2013

Training in Intensive Care Medicine

CURRICULUM MAP

SurveyDiversity ++54 ICM training programmes

Web-based Delphi5,241 suggestions535 contributors>50 countries

Questionnaire (patients, relatives)

70 ICUs 8 EU countries

CollaborationEU grant85 NCs42 countriesNational orgs

Nominal Group12 members169 competency statementsRating level & importance

Delphi iteration

Competency statements on website

SyllabusKnowledge, skills & attitudes for each

competence

AssessmentDescriptors of how competencies are

assessed in workplace

Educational ResourcesLearning & teaching

ESICM Div Prof Dev

European Board ICM

EDIC

CompetenciesFinal set of 102

How CoBaTrICE was developed: a 6 year project, 2003-06 & 2008-10

Discussions with COPMeD, GMC, Trustee Colleges, Trainers

• Stepped recruitment accepted as best approach:– 18 month window between appointment to 1st and

2nd CCT – Avoids risk of appointment to separate Deaneries /

UoAs for each CCT– Ensures top-ranked candidates appointed• Not feasible with concurrent independent recruitment

– Allows trainees time to ‘settle in’ to first CCT– Allows trainers time to plan, review trainee progress

GMC Approval of single-CCT ICM programmeOctober 3rd 2011

Dual CCTs: stepped recruitment

Recruitment key points• ICM now a primary speciality – like any other

– Parent specialities now partner specialities– Therefore independent recruitment processes

• Multidisciplinary ethos: hence Dual Programmes negotiated with GMC– Stepped appointment – 18 month window– CESR-CP after 18 months

• Single CCT-ICM does not mean that trainees can only be intensive care specialists – dual CCTs permits practice in both specialities

• This addresses the concern that the new programme might produce specialists for which there were too few consultant posts.

• Workforce planning in progress to determine current and future balance between training numbers and available consultant posts

ICM RecruitmentThanks to West Midlands Deanery for exemplary support in hosting

ICM recruitment1st round April 2012:• 72 new posts offered by Deaneries for 2012 – a

significant achievement• National recruitment process developed and

interview panels trained within a few months• Scotland and Northern Ireland would retain local

processes for 1st round.2nd round May 1st & 2nd 2013:• 94 new posts (including 10 military) – Thanks to COPMeD for this support

• March 11th 2013: Recruitment opens• May 1st & 2nd: Interviews: Birmingham

City Football Ground

Special thanks to: Tom Gallacher, Alison Pittard, Manjit Kaur, Daniel Waeland, James Goodwin, FICM-RAs & West Mids Deanery

ICM 2012 Recruitment Process and Outcomes

3 ‘Manned’ interview stations

2 ‘Un-manned’ interview stations

Trainees in ICM: Partner specialities and outcomes

since 2001

What do the new ICM-CCT programmes look like?

Single CCT programmes in ICM:Entry from ACCS

Single CCT programmes in ICM:Entry from CAT

Single CCT programmes in ICM:Entry from CMT

Academic Training – a strategic priority

ICM Academic Training (England)

Academic Clinical Training in Scotland: http://www.ecat.ed.ac.uk/

Dual Programmes: ICM + partner specialities

• Entry from Anaesthesia and from Resp Med shown on next slides – other examples available for EM, AIM, Renal Med.

• Other partnerships possible but not yet worked out.

• Dual CCTs prolong training by 18 months– Longer might be required for other partner

specialities• Two examples on next slide...

Examination & AssessmentChair of Examiners: Prof Nigel Webster

Deputy Chair: Dr Andrew Cohen

• Two-part Fellowship exam– Part I can be primaries from FRCA, MRCP, MCEM...

• Or basic level MCQ for ICM primary spec prog

– Part II: MCQs; Clinical-OSCEs/Vivas • Exam window: ST5-6. Required to pass to ST7• First sitting: Jan 9th 2013: 82 candidates• Pass rate for MCQ: 75%

• Annual Review of Competence Progression: – Two structured case histories each year, ST1-5– Higher degree or publications used as evidence– E-portfolio in development 2013

• Links with European Diploma of ICM – for consideration

ICM Workforce Planning

ICM an increasingly popular choice at undergraduate level

Advanced Critical Care Practitioners

• Will provide essential ‘middle tier’ support in the ICU, and likely to contribute substantially to quality improvement and reliability of care

• Curriculum first draft completed (Anna Batchelor, Graham Nimmo)

• Quality assurance: – portfolio assessment & certification initially– Examination planned longer term

• Practitioner membership of the Faculty• Working group to become Programme board

with ACCP involvement and ownership

Workforce Planning Actions:

• 300 ICM training posts required each year now to maintain current (2013) workforce

• Aim for 600 by 2023• May require 900 by 2035• Modelling required to include national

reconfiguration of NHS – working with CfWfi and Trustee colleges

• Develop undergraduate training in ICM and ACCP programmes

Summary

• ICM a primary speciality• Multidisciplinary ethos – dual CCTs– Administrative arrangements manageable with prior

planning• Increasingly popular speciality choice for

undergraduates as well as postgrads• Service demand will increase substantially over next

20 years• Workforce planning this year will provide more

secure estimates of expansion required• Thanks to COPMeD for their support.