Intensive Care Medicine

Training In Intensive Care Medicine

Training in Intensive Care Medicine (ICM) can be undertaken alongside a primary specialty of Anaesthesia, Medicine, Emergency Medicine or Surgery. All training is competency based as set out by the Intercollegiate Board for Training in Intensive Care Medicine (IBTICM).

Preliminary

Preliminary training in Intensive Care can be achieved in any of the regional ICUs with training accreditation. This normally lasts 3 months and occurs during the first 2 years of specialist training within Anaesthesia or Medicine. All the units belong to the relevant Department of Anaesthesia; however Oxford has a history of attracting trainees to Intensive Care via General Internal Medicine and Emergency training, and the Adult Intensive Care Unit (AICU) consultant body is made up of both Anaesthetists and Physicians.

Core

Core training normally lasts 6 months and is taken in one or two blocks. Again this can take place in any unit with training accreditation, but at least 3 months tends to occur in the Oxford Adult Intensive Care Unit. During this period of training trainees complete 10 extended case histories.

Complimentary Specialist training

All trainees must complete a period of training in both anaesthesia and medicine. Opportunities exist within the region for anaesthesia trainees to get medical experience and vice versa as part of the Acute Care Common Stem program (ACCS).

CCT Program and Enhanced Training

The Oxford region runs a successful dual CCT program in Intensive Care. At the time of writing there are five numbered posts in the region that lead to a dual CCT of ICM and the trainee's primary specialty. Candidates apply in ST3-5 (SpR1-3) of their primary specialty for this popular training scheme, which consists of 12-18 months out of programme advanced training, finishing within a year of their primary training completion date.

This more advanced training is based in the Adult Intensive Care Unit (AICU); however modules of specialised ICM are available in Cardiothoracic, Neurological and Paediatric Intensive Care. Specialist training can be organised in microbiology, radiology and hepato-biliary ICM. In addition to comprehensive critical care training, the successful candidates have opportunities to develop experience in management, research, teaching and audit. They are encouraged to lead ward rounds with appropriate supervision and take a lead role in the organization of medical staff. There is even an opportunity to travel to Hong Kong on a fully funded travel bursary.

In addition to this scheme there are potential opportunities for anaesthesia trainees to gain Advanced Training Recognition in ICM outside the CCT program, by rotating through the AICU as part of Additional Study Modules.

FTSTA posts in Intensive Care

A more recent development is the introduction of 6 FTSTA posts in the region all based at The Oxford Radcliffe Hospitals Trust. The objective of these posts is to provide a thorough grounding in ICM. They are suitable both for trainees who subsequently might wish to practice the specialty and those who expect to practice hospital medicine in an acute specialty in which there is currently no provision for training in ICM, but for which training in ICM is of value. Examples include but are not limited to emergency, acute medicine, cardiology, chest medicine, cardiothoracic surgery and nephrology.

The scheme will provide training in the care of the critically ill patient as per guidelines set out by the Intercollegiate Board for Training in Intensive Care Medicine (IBTICM). The posts last 6-12 months and aim to incorporate Preliminary (Basic) and Core (Step 1) training dependant on length of appointment. There is potential to include complimentary specialty training within the scheme for exceptional candidates who are planning a future career in ICM. They are suitable for trainees who have done no formal ICM or have up to one years training in the specialty.

ICM Teaching

Intensive Care ST1/2 study days

These days are exclusively for ST1-2 and run twice a year at Wexham Park Hospital. Basic Intensive Care issues are approached through a combination of small group sessions and lectures from regional experts. The use of innovative teaching techniques attracts large numbers and formal feedback continues to be excellent.

Basic Course

The Basic Assessment and Support in Intensive Care (BASIC) course was designed by Charles Gomersall of the University of Hong Kong and has rapidly achieved international recognition. It was run for the first time in the Oxford region on March 27/28th and repeated four times during the year. The two day course covers the assessment of the critically ill patient, mechanical ventilation, haemodynamic monitoring, shock, acute renal failure, trauma, neurological emergencies, sepsis, arrhythmias, airway management and transfer. The topics are covered by a series of lectures and reinforced by a series of small group tutorials and skill stations delivered by an expert faculty of experienced clinicians. It is currently offered free to ACCS and ICM trainees in the region. It is organised and managed by Dr Julian Millo, the ICM Tutor at the John Radcliffe Hospital.

Transfer training days

Thames Valley Critical Care Network delivers training in the transfer of the critically ill patient to all critical care trainees in the region. This multi-disciplinary centrally funded one day course was developed in the region and now runs several times a year. Candidates are not only trained to facilitate safe transfer, but also to consider the clinical and strategic aspects, informed by National guidelines and the Network organisation.

ALERT training

ALERT stands for Acute Life-threatening Illness Recognition and Training. This multi-disciplinary one day course runs several times a year in various hospitals in the region. Over 2000 candidates have now been taught the basic skills needed to look after the critically ill patient outside the ICU. The course uses innovative teaching techniques such as role play and high-fidelity simulators. The course therefore provides an ideal setting for critical care trainees to develop their own teaching skills with the support of experienced educationists and experts in the area.

Kadoorie Critical Care and Trauma Training and Research Centre

This purpose built training and research centre is at The John Radcliffe Hospital in Oxford. The teaching facilities include state-of-the art audio-visual equipment and a high-fidelity simulator in a realistic clinical environment. The active research group focuses on critical care and trauma, and is responsible for co-ordination of both local and national trials. Integral to this professional set up is the co-option of critical care trainees into research projects. This provides a fantastic opportunity for senior critical care and anaesthesia trainees to get involved in high quality research during their clinical training.

Kadoorie Training fellowship

Each year a critical care trainee within the Oxford region is awarded a fully funded travel bursary to visit The Prince of Wales Hospital Intensive Care Unit in Hong Kong. The award is made on the basis of a proven track record of commitment to ICM training, the 10 case histories and dissertation prepared for the diploma exam. As far as we are aware Oxford is the only region in the country to offer such an award to a critical care trainee and so represents a fantastic opportunity.

Dr Andrew Walden has been awarded this year Kadoorie training fellowship and therefore receives a fully funded two week trip to visit Intensive Care Units in Hong Kong. Anyone interested in next years prize should contact Dr Jonathan Chantler.

Diploma Teaching

All senior trainees are encouraged to sit the UK Diploma in Intensive Care Medicine during their final year. Support is given, particularly in dissertation and case history supervision, and a high success rate is maintained.

Oxford Region Intensive Care Units