ICM CURRICULUM:

SUPPORTING EXCELLENCE
for a CCT in
Intensive Care Medicine

VERSION 1.2
August 2021
 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

Change log
This document outlines the curriculum to be used by doctors completing postgraduate training in Intensive Care
Medicine in the UK. It is accompanied by the Assessment strategy for Intensive Care Medicine.

This is Version 1.2.

As the document is updated, version numbers will be changed, and content changes noted in the table below.

Version number Date issued Summary of changes

Original publication – the date of August 2021 is kept on the

1.0 August 2021 publication at GMC request for all subsequent versions, to make
clear the date of curriculum implementation.
Updated references to dual CCTs programmes to include the
1.1 October 2021 approved triple CCTs of ICM with Internal Medicine and one of Acute
Internal Medicine, Respiratory Medicine or Renal Medicine.

1.2 December 2021 Included section 5.7 on Acting up as a Consultant

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

Contents
Contents ................................................................................................................................................................................................ 3

1. Introduction to the Intensive Care Medicine Curriculum .......................................................................................................5

2. Purpose ................................................................................................................................................................................................ 5

2.1. Purpose of the ICM Curriculum ........................................................................................................................................................................................................................................................................... 5

2.2. Rationale for the ICM curriculum .................................................................................................................................................................................................................................................................... 10

2.3. Development of the ICM curriculum ........................................................................................................................................................................................................................................................... 11

3. The ICM training pathway and entry requirements .............................................................................................................. 12

3.1. The training pathway ........................................................................................................................................................................................................................................................................................................ 12

3.2. Dual CCTs ...........................................................................................................................................................................................................................................................................................................................................16

3.3. Triple CCTs......................................................................................................................................................................................................................................................................................................................................... 17

3.4. Pre-Hospital Emergency Medicine (PHEM) ....................................................................................................................................................................................................................................... 17

3.5. Paediatric Intensive Care Medicine (PICM)......................................................................................................................................................................................................................................18

4. Content of Learning ......................................................................................................................................................................... 18

4.1. Spiral’ Learning ............................................................................................................................................................................................................................................................................................................................18

4.2. Generic Professional Capabilities and Good Medical Practice.......................................................................................................................................................................19

4.3. High-Level Learning Outcomes (HiLLOs) ............................................................................................................................................................................................................................................ 20

4.4. Special Skills ................................................................................................................................................................................................................................................................................................................................... 20

4.5. Local decisions about the training programme .................................................................................................................................................................................................................... 21

5. Programme of Learning ................................................................................................................................................................. 22

5.1. The training programme........................................................................................................................................................................................................................................................................................... 22

5.2. The training environment ......................................................................................................................................................................................................................................................................................... 22

5.3. Educational strategies .................................................................................................................................................................................................................................................................................................. 23

5.4. Teaching and learning methods.................................................................................................................................................................................................................................................................. 23

5.5. Academic training ..............................................................................................................................................................................................................................................................................................................25

5.6. Out of hours commitments ................................................................................................................................................................................................................................................................................. 26

5.7. ‘Acting Up’ as a consultant ................................................................................................................................................................................................................................................................................. 27

6. Programme of Assessment ......................................................................................................................................................... 28

6.1. Aims.......................................................................................................................................................................................................................................................................................................................................................... 28

6.2. Programme of assessment ................................................................................................................................................................................................................................................................................. 28

6.3. The Fellowship of the Faculty of Intensive Care Medicine..................................................................................................................................................................................... 29

6.4. Assessment of High-Level Learning Outcomes ..................................................................................................................................................................................................................... 29

6.5. Critical Progression Points....................................................................................................................................................................................................................................................................................... 30

6.6. High-Level Learning Outcomes Grid....................................................................................................................................................................................................................................................... 30

6.7. Evidence of progress....................................................................................................................................................................................................................................................................................................... 32

7. Training progression and the ARCP process........................................................................................................................... 40

7.1. Progression and the Programme of Assessment .............................................................................................................................................................................................................. 40

7.2. Assessments within complementary specialties or special skills years ............................................................................................................................................. 41

7.3. The ARCP............................................................................................................................................................................................................................................................................................................................................... 41

7.4. Trainees requiring additional support..................................................................................................................................................................................................................................................... 41

7.5. ICM Assessment Blueprint ........................................................................................................................................................................................................................................................................................ 43

7.6. Special Skills Modules Assessment Blueprint ............................................................................................................................................................................................................................... 47

8. Supervision and feedback............................................................................................................................................................ 52

8.1. Supervision......................................................................................................................................................................................................................................................................................................................................52

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

8.2. Appraisal........................................................................................................................................................................................................................................................................................................................................... 53

9. Quality management .................................................................................................................................................................... 55

10. Intended use of the curriculum by ICM trainers and trainees ........................................................................................... 56

11. Equality and diversity .................................................................................................................................................................... 58

12. Annexes ............................................................................................................................................................................................. 59

Annex A – ICM High-Level Learning Outcomes ........................................................................................................................................................................................................................................ 59

Annex B – Special Skills Modules: Learning Objectives.................................................................................................................................................................................................................... 73

Annex C – Abbreviations............................................................................................................................................................................................................................................................................................................. 83

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

1. Introduction to the Intensive Care Medicine Curriculum

This document identifies the purpose, content of learning, process of training, and the programme of
assessment for postgraduate specialist training leading to a Certificate of Completion of Training [CCT] in
Intensive Care Medicine (ICM).

2. Purpose
2.1. Purpose of the ICM Curriculum
This purpose statement addresses the requirements of the General Medical Council’s, ‘Excellence by design:
standards for postgraduate curricula’ to include a clear statement, addressing patient and service needs, and
the scope of practice and competency expected of those completing training.

Intensive Care Medicine [ICM], is the body of specialist knowledge and practice concerned with the treatment
of patients with, at risk of, or recovering from potentially life-threatening failure of one or more of the body’s
organ systems. It includes the provision of organ system support, the investigation, diagnosis, and treatment
of acute illness, systems management and patient safety, ethics, end-of-life care, and the support of families.

Intensive Care Medicine specialists are therefore medical experts in:

• Resuscitation
• Advanced physiological monitoring
• Provision of advanced organ support (often multiple)
• Diagnosis and disease management in the context of the most gravely ill patients in the hospital
• Provision of symptom control
• Management and support of the family of the critically ill patient
• End of life care
• Collaboratively leading the intensive care team
• Coordination of specialist and multi-specialty input to complicated clinical cases in the unique context of
intensive care.

The management of intensive care patients by doctors who are specialists in Intensive Care Medicine and
whose primary function is the work of Intensive Care Medicine has been demonstrated to have a significant
beneficial influence on outcomes for patients, with a decrease in mortality and a reduction of complications. 1

A doctor completing the training programme in ICM will be able to fulfil the above requirements and their
progress will be assessed at key progression points during their training.

The development of the syllabus for the CCT in ICM has drawn extensively on the Competency Based Training
in Intensive Care Medicine in Europe (CoBaTrICE) syllabus. The latter is an international partnership of
professional organisations and critical care clinicians working together to harmonise training in Intensive Care
Medicine worldwide. The CoBaTrICE Collaboration was formed in 2003 to define outcomes of specialist ICM
training and to develop an international training programme in ICM for Europe and other world regions. The
project was part-funded by the European Commission and the European Society of Intensive Care Medicine.
Consensus techniques were used to enable interested stakeholders (health care professionals, educators,
patients and their relatives) to identify and prioritise core competencies required of a specialist in ICM.

1
Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis. Hutchings A, Durand MA, Grieve R, Harrison D, Rowan K, Green J,
Cairns J, Black N. BMJ. 2009 Nov 11;339:b4353. doi: 10.1136/bmj.b4353.

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

Individuals and groups from 29 countries contributed to the process whereby 102 competence statements
divided into 12 domains were agreed as the desired final syllabus for doctors in training in ICM.

The training programme is based on the concept that ensures that the basic principles learnt and understood
are repeated, expanded and further elucidated as time in training progresses; this also applies to the
acquisition of skills, attitudes and behaviours. The outcome is such that mastery of the specialty to the level
required to commence independent practice in a specific post is achieved by the end of training as
knowledge, skills, attitudes and behaviours metaphorically spiral upwards.

The Intensive Care Curriculum has 14 High Level Learning Outcomes (HiLLOs) of which 4 are generic and 10 are
specialty specific (as outlined at a high level in the table below) with their associated Generic Professional
Capabilities (GPC) domains.

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

GPC
Intensive Care Medicine Curriculum High-Level Learning Outcomes
Domains
The doctor will be able to function successfully within NHS organisational and management
1 1,2,3,6,7
systems whilst adhering to the appropriate legal and ethical framework.

The doctor will be focused on patient safety and will deliver effective quality improvement, whilst
2 1,2,4,6,7,9
practising within established legal and ethical frameworks.

An Intensive Care Medicine specialist will know how to undertake medical research including the
3 1,9
ethical considerations, methodology and how to manage and interpret data appropriately.
To ensure development of the future medical workforce, a doctor working as a specialist in
4 Intensive Care Medicine will be an effective clinical teacher and will be able to provide 1,8
educational and clinical supervision.
Doctors specialising in Intensive Care Medicine can identify, resuscitate and stabilise a critically
5 ill patient, as well as undertake their safe intra-hospital or inter-hospital transfer to an 2,5,6
appropriately staffed and equipped facility.
Intensive Care Medicine specialists will have the knowledge and skills to initiate, request and
interpret appropriate investigations and advanced monitoring techniques, to aid the diagnosis
6 and management of patients with organ systems failure. They will be able to provide and 2,3
manage the subsequent advanced organ system support therapies. This will include both
pharmacological and mechanical interventions.
Specialists in Intensive Care Medicine can provide pre-operative resuscitation and optimisation
7 of patients, deliver post-operative clinical care including optimising their physiological status, 1,2,5
provide advanced organ system support and manage their pain relief.
Doctors specialising in Intensive Care Medicine will understand and manage the physical and
psychosocial consequences of critical illness for patients and their families, including providing
8 pain relief, treating delirium and arranging ongoing care and rehabilitation. They will also 2,3,5
manage the withholding or withdrawal of life-sustaining treatment, discussing end of life care
with patients and their families and facilitating organ donation where appropriate.
Intensive Care Medicine specialists will have the skillset and competence to lead and manage a
9 critical care service, including the multidisciplinary clinical team and providing 2,3,5,7
contemporaneous care to a number of critically ill patients.
Intensive Care Medicine specialists will have developed the necessary skills of induction of
10 anaesthesia, airway control, care of the unconscious patient and understanding of surgery and 2,5
its physiological impact on the patient.
In order to manage acutely ill patients outside the Intensive Care Unit, an Intensive Care
Medicine specialist will have the diagnostic, investigational and patient management skills
11 1,2,5
required to care for ward-based patients whose condition commonly requires admission to the
intensive care unit.
Doctors specialising in Intensive Care Medicine understand the special needs of, and are
competent to manage patients with neurological diseases, both medical and those requiring
12 2,5
surgery, which will include the management of raised intracranial pressure, central nervous
system infections and neuromuscular disorders.
A specialist in adult Intensive Care Medicine is competent to recognise, provide initial
stabilisation and manage common paediatric emergencies until expert advice or specialist
13 2,5,7
assistance is available. They are familiar with legislation regarding safeguarding children in the
context of Intensive Care Medicine practice.
Intensive Care Medicine specialists recognise the special needs of, and are competent to
provide the perioperative care to, patients who have undergone cardiothoracic surgery
14 2,5
including providing pain relief and advanced organ system support utilising specialised
techniques available to support the cardiovascular system.

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

Intensive Care Medicine training is divided into 3 distinct stages with associated progression points where
specific criteria must be met to proceed to the next stage of training. It is recognised that these progression
points are based on a trainee’s ability and that this will tend to vary from trainee to trainee. Therefore, where a
period of time in a specific module or stage of training is suggested below, these times are to be interpreted
as typical times that the Faculty would expect a trainee to spend in a particular module or stage of training in
order to achieve the necessary criteria for progression. The final arbiter on whether a trainee has successfully
achieved the requirements to progress beyond a progression point will be the Annual Review of Competence
Progression (ARCP) panel with the Faculty providing oversight and advice as required.

Stage 1 ICM (CT1-ST4) training consists of an initial indicative four-year block of training. Years 1 and 2 will be
spent in Stage 1 Anaesthetics, Internal Medicine or Acute Care Common Stem (ACCS) training programmes.
Competitive entry to ST3 will occur following acquisition of the capabilities required of the relevant core
training programme and its associated examination, namely, Primary FRCA, MRCP(UK) or MRCEM obtained prior
to August 2018 or FRCEM Primary (or MRCEM Part A after August 2012) AND FRCEM Intermediate SAQ (or MRCEM
Part B after August 2012) AND FRCEM Intermediate SJP. The ST3 and ST4 years are intended to consolidate the
trainee’s knowledge and skills in general diagnosis and patient management and enable trainees who enter
from a variety of core programmes to achieve the designated capability levels in ICM by the end of ST4.

Successful completion of Stage 1 (and therefore progression) involves an indicative training time of 12 months
each in Anaesthetics, Internal Medicine and ICM across the recommended four years of the training Stage as
well as the corresponding core training programme examination. All training times are indicative and can be
altered at the discretion of the Annual Review of Competence Progression Panel in line with the General
Medical Council’s standards for postgraduate curricula.

Stage 2 ICM (ST5-6) covers an indicative 12 months ICM training in 3 specialist areas of practice, namely,
paediatric ICM, neurosurgical and neurological ICM and cardiothoracic ICM. It also allows trainees an
indicative 12 months to develop a special skill or area of expertise that will benefit patients and the service in
general and to consolidate their general ICM training.

In many hospitals, patients presenting acutely, with for example, head trauma or paediatric sepsis will need
the skills and expertise of Intensive Care Medicine doctors to institute resuscitation and stabilisation prior to
transfer or retrieval. Therefore, during the programme, time must be spent in developing skills and
competencies associated with the specialist areas of cardiothoracic, neurosciences and paediatric ICM
practice. The Faculty would expect this to typically involve a 3-month placement in each of these areas with
the opportunity to either consolidate one or all of the trainee’s specialist ICM skills or their general intensive
care medicine experience contributing to an indicative 12 months of training.

In the other indicative 12 months of Stage 2, trainees in ICM must develop an area of special expertise which
will be of direct benefit to the service and patient care, acquired during a Special Skills year. Intensive Care
Medicine has a history of practitioners from many different backgrounds bringing skills and competencies into
the Intensive Care Unit. Expertise can be gained in one of 11 prior approved specialist areas including research
in ICM, quality improvement and education as well as specific skills such as echocardiography and catering
for the special needs of patients who require extra-corporeal membrane oxygenation (ECMO).

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

Progression from Stage 2 will require the trainee to have completed the above training, gained the required
competencies and successfully completed the Fellowship of the Faculty of Intensive Care Medicine (FFICM)
examination.

Stage 3 ICM consists of the final stage of ICM training (ST7) and comprises a recommended 12 month period,
which must be spent in Intensive Care Units consolidating the trainee’s competencies and acquiring high-
level management and administrative skills, progressively achieving autonomy so that they are competent to
take up a consultant post in ICM.

Upon completion of Stage 3, the trainee will be recommended for their CCT in Intensive Care Medicine having
successfully achieved all the curriculum outcomes to the standard expected of a specialist in Intensive Care
Medicine capable of independent practice.

The curriculum will equip doctors to undertake independent practice in all aspects of Intensive Care Medicine
likely to be encountered in non-specialist practice, as well as the ability to recognise and stabilise patients
who present in a general setting but require specialist ICM care in a specialist centre. It will also provide them
with sound basis for developing specialist practice in areas such as paediatric, neurological/neurosurgical
and cardiothoracic ICM, where there is the workforce need.

The curriculum will provide the foundation on which specialist ICM practice can be further developed but will
not equip doctors to undertake such specialist practice unless they have undertaken a special skills module in
that area of practice. In addition to the special skills module, these extra competencies and experience are
gained either as part of an out of programme period of additional training whilst undertaking the CCT
programme or as post CCT training undertaken after entry onto the specialist register.

Intensive Care Medicine (ICM) specialists underpin the clinical care delivered in all areas of an acute hospital
including theatres, maternity units, acute medical and surgical wards, imaging and the emergency
departments. From a clinical governance perspective, a suitable on-site intensive care facility is mandatory if
a hospital is to provide the above services. Intensive Care Medicine delivers a 24 hours a day, seven days a
week, consultant-led and delivered service providing equity of access to intensive care and consultant ward
rounds.

The ICM specialist is responsible for leading a multi-disciplinary team and co-ordinating other teams of
clinicians both medical and non-medical and the curriculum provides for the acquisition of these skills.

During its development the curriculum has undergone extensive consultation with stakeholders including:

• ICM trainees, trainers, Faculty Tutors, Regional Advisors, Training Programme Directors and Heads of
Schools.
• Partner specialties, namely the Royal College of Anaesthetists, Royal Colleges of Physicians and Royal
College of Emergency Medicine
• Lay and patient groups
• The Clinical Director networks of our own and partner specialties
• NHS Employers and their equivalent in the devolved nations
• COPMeD through the lead Postgraduate Dean

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

• Representative groups within FICM, including our Smaller & Specialist Units Advisory Group (with
responsibility for remote, rural and specialist units) and the Women in Intensive Care Medicine Committee
• Specialist organisations covering neurological/neurosurgical, cardiothoracic and paediatric ICM.

As the NHS moves to more integrated models of care, the boundaries between medical disciplines by
necessity become blurred and ICM is ideally placed to facilitate these changes since we accept entry into our
training programme from a wide range of acute care specialty programmes, namely Internal Medicine
Training, ACCS (Emergency Medicine), ACCS (Acute Internal Medicine), ACCS (Anaesthesia) and Core
Anaesthesia Training. In addition, a doctor can specialise in another specialty in conjunction with ICM meaning
that doctors can dual or triple qualify in ICM with one of our partner specialties: Acute Internal Medicine and
Internal Medicine, Emergency Medicine, Renal Medicine and Internal Medicine, Respiratory Medicine and
Internal Medicine, and Anaesthesia, allowing them to practice in two or three specialties within a single
provider thus increasing flexibility for employers and patients alike.

The curriculum also requires that all doctors undertake a recommended 12-month period of training in our
partner specialties of Internal Medicine and Anaesthesia at core level, to acquire the necessary broad-based
experience and competencies to practice as an ICM specialist. This also allows the ICM specialist to better
understand the wider needs of other parts of the hospital, improving patient experience and flow.

Intensive Care Medicine fulfils the requirement to provide flexibility in training pathways for doctors in training. It
formally recognises capabilities already acquired from Anaesthesia, Emergency Medicine and Internal
Medicine Training programmes by virtue of its Stage 1 training requirements. It also formally recognises
capabilities obtained in those specialties with which it shares dual training programmes. Capabilities will
therefore also be recognised for ICM training if acquired during training in Internal Medicine, Acute Internal
Medicine, Respiratory Medicine, Renal Medicine, Anaesthesia and Emergency Medicine irrespective of whether

they were gained as part of a dual or triple training programme with ICM or in one of those partner specialty’s

CCT programmes. Capabilities acquired within ICM training will be similarly recognised and transferrable to
these specialties. It will also be possible to transfer some capabilities from and to all acute specialties due to
the broad scope of ICM training but the specific capabilities will be significantly less than those listed above.

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and the curriculum has
been confirmed as meeting the needs of the health services of the four countries of the UK.

2.2. Rationale for the ICM curriculum

The Shape of Training Review 2 and the GMC’s Excellence by design: standards for postgraduate curricula 3
provide an opportunity to reform postgraduate training to produce a workforce fit for the needs of patients,
producing a doctor who is more patient focused, more general and has more flexibility in career structure. The
GMC’s introduction of updated standards for curricula and assessment processes laid out in Excellence by
design, requires all medical curricula to be based on high-level outcomes and also to incorporate the GPC
framework 4. The HiLLOs in this curriculum constitute 4 generic and 10 specialty-specific learning outcomes to
be achieved by all ICM trainees as they progress through each stage of training, and ultimately attain a CCT.

2
https://www.shapeoftraining.co.uk/static/documents/content/Shape_of_training_FINAL_Report.pdf_53977887.pdf
3
https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/excellence-by-design
4
https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/generic-professional-capabilities-framework

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

The curriculum for Intensive Care Medicine incorporates and emphasises the importance of the GPCs, which
provide the educational articulation of Good Medical Practice 5. Such common capabilities will promote
flexibility in postgraduate training in line with the recommendations set out in the GMC’s report to the four UK
governments 6, ensuring a sustainable model for ICM training agile enough to respond to evolving patient
need and service opportunities, as well as resulting in a more flexible, adaptable workforce.

The curriculum provides further detail and guidance as to how the HiLLOs can be achieved and demonstrated
in Section 6: Programme of Assessment and Annex A.

2.3. Development of the ICM curriculum

Responsibility for the ICM curriculum rests with the FICM’s Training, Assessment and Quality (TAQ) Committee.
The committee established the Curriculum Working Group (CWG) with delegated responsibility for setting the
direction of the curriculum revisions and overseeing and approving the review work, working in tandem with
the TAQ Committee. The committee’s membership represents a wide range of stakeholders including
representatives from the FICM Board, the Lead Dean for ICM, the Lead Regional Advisor for ICM, Faculty Tutors,
Intercollegiate Board for Training in Pre-Hospital Emergency Medicine (IBTPHEM), Acute Care Common Stem
(ACCS), Training Programme Directors, and ICM trainees.

The curriculum for Intensive Care Medicine has been developed with the support and input of ICM trainees,
consultants actively involved in delivering teaching and training across the UK, specialist societies, service
representatives and lay persons. This has been through the work of the TAQ Committee and its subgroups and
at regular stakeholder engagement events.

2.3.1. Ongoing curriculum review

The curriculum will be reviewed regularly with an implementation date for any changes being not less than six
months after their publication date. All changes to the curriculum are prospectively approved by the GMC
before publication. When published, the curriculum document will be annotated with a different version
number, including a summary of the changes and will be available on the Faculty website.

Occasionally the FICM’s TAQ Committee may have to take decisions that will affect the immediate
interpretation or application of specific items in this curriculum document or its supporting guidance manuals.
These will be published as a ‘Training Programme Update’ circular to all ICM Regional Advisors, Faculty Tutors,
Training Programme Directors (TPDs) and Heads of Schools, as well as being cascaded to ICM trainees and
published on the Faculty website.

5
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice
6
https://www.gmc-uk.org/-/media/documents/adapting-for-the-future-a-plan-to-improve-postgrad-med-training-flexibility_pdf-69842348.pdf

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

3. The ICM training pathway and entry requirements

3.1. The training pathway
We accept entry into our programme following the completion of at least the first two years of a number of
acute care specialty programmes and successful completion of the respective primary exam (or equivalent)
for that specialty by the time of appointment, namely:

• Internal Medicine Training (IMT)

• Acute Care Common Stem (ACCS) (Emergency Medicine, Anaesthesia and Acute Internal Medicine)
• Core Anaesthesia Training (CAT)

No single, dedicated ICM core training scheme has been developed. This is a deliberate choice of the FICM
based on our philosophy, backed by evidence, that the delivery of ICM in the UK has been greatly
strengthened by the entry into ICM training of trainees with diverse medical backgrounds.

ACCS is a core training programme providing wide experience in management of patients presenting with
acute illness. It comprises an initial two years consisting of four 6 month posts in Acute Internal Medicine,
Anaesthesia, Emergency Medicine and Intensive Care Medicine.

CAT is currently a two-year core training programme for those planning a career in Anaesthesia but we
understand it will be moving to a 3 year core training programme when their new curriculum is introduced.
However, we refer you to the first paragraph in this section. It consists of rotations to allow trainees to gain
experience in core anaesthesia, the assessment of patients including the acutely ill, resuscitation skills and
some exposure to ICM.

IMT replaced Core Medical Training as the core training programme for those planning a career in Medicine or
one of its specialties in 2019. It consists of a nominal two years of rotations between both acute general
medicine and some exposure to specialties, which include ICM. A significant proportion of time is spent caring
for acutely ill patients reviewed as part of the acute medical take or in the Emergency Department.

Trainees who complete ST1-3 of the Emergency Medicine run-through programme are also eligible to enter
ICM training. This is on the basis that the competencies acquired in EM ST1-3 are the same as those acquired
by Emergency Medicine trainees who have completed the ACCS (Emergency Medicine) core programme.

The use of multiple core schemes in this ICM CCT allows that link to be maintained and strengthened by
facilitating the acquisition of dual or triple CCTs in ICM and a partner specialty. Trainees wishing to train in ICM
can enter higher specialist ICM training by any of the above core schemes.

Entry for higher specialist ICM training will generally occur at ST3 level by a competitive process.

The training programme acknowledges the fact that on entry to higher ICM training not all trainees will have
had an identical training experience. The first two years of higher ICM training (ST3-4) are designed to enable
all trainees to achieve the same learning outcomes and level of competency by the end of ST4. Stage 1 ICM
Training needs four indicative years to be completed, including 1 each of Internal Medicine, Anaesthesia and
ICM. The other years completed in core training programmes will count towards partner specialty progression

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

ICM training is outcome-based rather than time-based however, the indicative length of training is seven
years from appointment to completion (this includes the training acquired in one of the approved core
programmes). There will be options for those trainees who demonstrate exceptionally rapid development and
acquisition of capabilities to complete training earlier than the current indicative time, although it is
recognised that clinical experience is a fundamental aspect of development. There may also be a small
number of ICM trainees who develop more slowly and will require an extension of training in line with the
Reference Guide for Postgraduate Specialty Training in the UK (the Gold Guide 7). Those who choose less than
full-time training (LTFT) will have their indicative training time extended pro-rata in accordance with the Gold
Guide. ICM LTFT trainees should, pro-rata, undertake the same out-of-hours duties, including weekend duties,
as full-time colleagues in the same programme and at the equivalent stage. For more information on LTFT
training in ICM please consult the ICM Curriculum Handbook.

The ICM curriculum, and thus training programme, is divided into three Stages:

Stage 1 ICM (indicative 4 years - CT1-ST4): Years 1 and 2 will be spent in the Core Anaesthetic, Internal
Medicine or ACCS training programmes. Competitive entry to ST3 will occur following acquisition of the
competencies required of the relevant core training programme and its associated examination, namely,
Primary FRCA, MRCP(UK) or MRCEM obtained prior to August 2018 or FRCEM Primary (or MRCEM Part A after
August 2012) AND FRCEM Intermediate SAQ (or MRCEM Part B after August 2012) AND FRCEM Intermediate SJP.
The ST3 and ST4 years are intended to consolidate the trainee’s knowledge and skills in general diagnosis and
patient management and enable trainees who enter from a variety of core programmes to achieve the
designated competency levels in ICM by the end of ST4.

Successful completion of Stage 1 (and therefore progression) involves an indicative training time of 12 months
each in Anaesthesia, Internal Medicine and ICM across the recommended four years of the training Stage as
well as the corresponding core training programme examination. All training times are indicative and can be
altered at the discretion of the Annual Review of Competence Progression Panel in line with the General
Medical Council’s standards for postgraduate curricula.

Stage 2 ICM (ST5-6) covers an indicative 12 months ICM training in 3 specialist areas of practice, namely,
paediatric ICM, neurosurgical and neurological ICM and cardiothoracic ICM. It also allows trainees an
indicative 12 months to develop a special skill or area of expertise that will benefit patients and the service in
general and to consolidate their general ICM training.

In many hospitals, patients presenting acutely, with for example, head trauma or paediatric sepsis will need
the skills and expertise of Intensive Care Medicine doctors to institute resuscitation and stabilisation prior to
transfer or retrieval. Therefore, during the programme, time must be spent in developing skills and
competencies associated with the specialist areas of cardiothoracic, neurosciences and paediatric ICM
practice. The Faculty would expect this to typically involve a 3- month placement in each of these areas with
the opportunity to either consolidate one or all of the trainee’s specialist ICM skills or their general intensive
care medicine experience contributing to an indicative 12 months of training.

In the other indicative 12 months of Stage 2, trainees in ICM must develop an area of special expertise which
will be of direct benefit to the service and patient care, acquired during a Special Skills year. Intensive Care
Medicine has a history of practitioners from many different backgrounds bringing skills and competencies into

7
https://www.copmed.org.uk/gold-guide-8th-edition/

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the Intensive Care Unit. Expertise can be gained in one of 11 prior approved specialist areas including research
in ICM, quality improvement and education as well as specific skills such as echocardiography and catering
for the special needs of patients who require extra-corporeal membrane oxygenation (ECMO).

Progression from Stage 2 will require the trainee to have completed the above training, gained the required
competencies and successfully completed the Fellowship of the Faculty of Intensive Care Medicine (FFICM)
examination.

Stage 3 ICM (indicative 12 months – ST7) consists of the final stage of ICM training (ST7) and comprises a
recommended 12 month period, which must be spent in Intensive Care Units consolidating the trainee’s
competencies and acquiring high-level management and administrative skills, progressively achieving
autonomy so that they are competent to take up a consultant post in ICM. Upon completion of Stage 3 the
trainee will be recommended for their CCT in Intensive Care Medicine having successfully achieved all the
curriculum outcomes to the standard expected of a specialist in Intensive Care Medicine capable of
independent practice.

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3.2. Dual CCTs

In the UK, ICM training was traditionally delivered alongside other higher specialist training in the form of a Joint
CCT programme incorporating two CCTs. The majority of practicing Intensive Care Medicine specialists are
therefore also qualified in Anaesthesia, Emergency Medicine or one of the partner Medical specialties.

Members of the intensive care community believe that this multi-disciplinary training has been of great
benefit to critically ill patients in the UK. We therefore created dual training schemes to promote training in
ICM and other disciplines. In all of these, the trainees will need to acquire the full competencies of both
disciplines but by a suitable choice of training attachments and educational interventions this can be
achieved without undue prolongation of training.

The ‘Gold Guide’ gives specific advice on dual CCT training and the following sections are particularly relevant:

3.35 Where trainees are competitively appointed to a training programme leading to dual certification (e.g.
neurology and clinical neurophysiology), trainees are expected to complete the programmes in full and
obtain the competences set out in both curricula. Application to the GMC for a CCT/CESR/CEGPR(CP) should
only take place when both programmes are complete. The two CCTs should be applied for and awarded on
the same date and the expected end of training date for both CCTs therefore becomes the same date. 8

The GMC guidance on dual CCTs states that:

“Dual CCTs are available if the trainee can demonstrate achievement of the competences and
outcomes of both the approved curricula. Both potential trainees and selection panels must be clear
whether the appointment is for a dual or single CCT(s). Appointment to dual CCT programmes is through
competition.” 9

3.2.1. Mapping for dual CCTs

There are specific acute medical specialties where areas of competence overlap with those of Intensive Care
Medicine. To facilitate the creation of dual training programmes, the FICM and its trustee Colleges have
undertaken cross-mapping exercises of the relevant curricula to identify areas of commonality that will allow
trainees to acquire the full High-Level Learning Outcomes of both disciplines via a suitable choice of training
attachments and educational interventions whilst avoiding undue prolongation of training. The specialties
encompassed in this mapping are:

• Anaesthesia
• Emergency Medicine

The indicative timeframe for each of these dual programmes is 8.5 years.

Trainees wishing to obtain dual certification in one of the above CCT specialties and in the single ICM specialty
will be able to obtain a proportion of the other specialty High-Level Learning Outcomes and assessments
during ICM training, and vice-versa. The shared High-Level Learning Outcomes and forms of assessment have
been identified by a joint working group between the relevant College (ie the Joint Royal Colleges of
Physicians’ Training Board (JRCPTB), the Royal College of Anaesthetists and the Royal College of Emergency

8
A Reference Guide for Postgraduate Specialty Training in the UK, Modernising Medical Careers, Seventh Edition, 2017, p24.
9
GMC. Improving the national consistency and approval of dual CCT training programmes. 2015.

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Medicine) and the FICM, and are documented in the dual CCT guidance produced by the relevant College
and the Faculty of Intensive Care Medicine.

Detailed guidance documents on duals CCTs for ICM and its partner specialties can be found online.

3.3. Triple CCTs

Prior to the introduction of the new 2021 curriculum, trainees in Respiratory, Renal and Acute Internal Medicine
could also apply to train in ICM and achieve a dual CCT. These groups of consultants provide an essential part
of a modern Critical Care Service. The new curriculum for these medical specialties now compulsorily
incorporates training in Internal Medicine (IM), resulting in dual CCTs in, for example, Respiratory Medicine and
Internal Medicine. Addition of ICM therefore results in a triple CCT. This new development adds extra content to
the programme for physicians wishing to train in ICM, but also produces consultants with broad skills ideally
suited to the changing demands of an evolving, modern Critical Care Service.

The principles of training for a triple CCT are identical to those outlined above for dual CCTs. Delivery of training
however needs to take into account managing three curricula rather than two. The addition of the CCT in
Internal Medicine demands careful communication between the Training Programme Directors to plan for a
rotation that is effective, and outcome focused. Cross-mapping exercises have shown a considerable overlap
between the specialties, which allows the Learning Outcomes for the respective curricula to be achieved as
efficiently as possible. However, there are capabilities which can only be achieved within a specific attachment.
Consideration should be given to combining assessments and reviews wherever possible.

The specialties encompassed in this mapping are:

• Internal Medicine and Acute Internal Medicine

• Internal Medicine and Renal Medicine
• Internal Medicine and Respiratory Medicine

The indicative timeframe for each of the triple CCT programmes is 8.5-9.5 years.

Detailed information is provided in the accompanying guidance on triple CCTs that can be found online.

3.4. Pre-Hospital Emergency Medicine (PHEM)

Trainees have the option of completing their CCT in Intensive Care Medicine with sub-specialty accreditation
in Pre-Hospital Emergency Medicine (PHEM). Entry into the PHEM sub-specialty programme is via a competitive
national application process during Stage 1 training (ST4 at the earliest for single ICM trainees) for a
programme commencement in Stage 2 training (ST5 or 6). Trainees would then undertake PHEM as their
Special Skills Year within ICM training.

Undertaking PHEM sub-specialty training is separate to undertaking an ICM Special Skills module in Transfer
Medicine; whilst PHEM and the Transfer Medicine Special Skills module contain some shared High-Level
Learning Outcomes, they are by no means identical and do not have the same learning outcomes. In addition,
the PHEM programme must be entered via competitive national application and interview.

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The full syllabus for PHEM training is not reproduced within this manual; trainees should refer to the
full PHEM curriculum available via the Intercollegiate Board for Training in Pre-Hospital Emergency
Medicine (IBTPHEM). 10

3.5. Paediatric Intensive Care Medicine (PICM)

Trainees have the opportunity of completing their CCT in Intensive Care Medicine with subspecialty
accreditation in Paediatric Intensive Care Medicine (PICM). Entry into the PICM subspecialty programme is via
an open and competitive national application process during Stage 1 training (single ICM CCT trainees must
have examinations deemed equivalent to a primary FFICM and have completed ST4 by the time of entry) to
commence the programme in ICM Stage 2 training.

The training requirements for PICM are set by the Paediatric Intensive Care Medicine Intercollegiate Specialty
Advisory Committee [PICMISAC], with representation from the Royal College of Paediatrics and Child Health
(RCPCH), FICM, RCoA and Paediatric Intensive Care Society. The RCPCH are the GMC-designated Lead College
for the subspecialty of PICM. The application process for entry to PICM CCT subspecialty training is overseen
entirely by the RCPCH and runs as part of their NTN Grid training programme. 11

Please note that the full syllabus for PICM training is not reproduced within this manual; trainees
should refer to the full PICM curriculum available via the RCPCH website. 12

4. Content of Learning

4.1. ‘Spiral’ Learning

The training programme is based on this concept, which ensures that the basic principles learnt and
understood are repeated, expanded and further elucidated as time in training progresses; this also applies to
the acquisition of skills, attitudes and behaviours. The outcome is such that mastery of the specialty to the
level required to commence independent practice in a specific post is achieved by the end of training as
knowledge, skills, attitudes and behaviours metaphorically spiral upwards.

10
www.ibtphem.org.uk
11
https://www.rcpch.ac.uk/resources/apply-sub-specialty-training-ntn-grid-guidance
12
https://www.rcpch.ac.uk/sites/default/files/2018-03/paediatric_intensive_care_medicine_syllabus_final.pdf.

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4.2. Generic Professional Capabilities and Good Medical Practice

The GMC has developed the Generic Professional Capabilities (GPCs) framework 13 with the Academy of
Medical Royal Colleges (AoMRC) to describe the fundamental, career-long, generic capabilities required of
every doctor. The framework describes the requirement to develop and maintain key professional values and
behaviours, knowledge, and skills, using a common language. GPCs also represent a system-wide, regulatory
response to the most common contemporary concerns about patient safety and fitness to practise within the
medical profession. The framework will be relevant at all stages of medical education, training and practice.

Good Medical Practice (GMP) 14 is embedded at the heart of the GPC framework. In describing the principles,
duties and responsibilities of doctors the GPC framework articulates GMP as a series of achievable
educational outcomes to enable curriculum design and assessment. The GPC framework describes nine
domains with associated descriptors outlining the ‘minimum common regulatory requirement’ of
performance and professional behaviour for those completing a CCT or its equivalent. These attributes are
common, minimum and generic standards expected of all medical practitioners achieving a CCT or its
equivalent.

The 9 domains of the GPC framework are directly identifiable in the ICM curriculum. They are mapped to each
of the generic and specialty specific HiLLOs, which are in turn mapped to the assessment blueprints. This is to
emphasise the core professional capabilities that are essential to safe clinical practice and that they must be
demonstrated at every stage of training as part of the holistic development of responsible professionals. This
approach will allow early detection of issues most likely to be associated with concerns regarding fitness to
practise and to minimise the possibility that any deficit is identified during the final phases of training.

13
GMC GPC Framework
14
GMC Good Medical Practice

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4.3. High-Level Learning Outcomes (HiLLOs)

The ICM curriculum contains 14 HiLLOs that specify the standard that ICM specialists must demonstrate as they
progress through training and ultimately attain a CCT. ICM trainees are required to demonstrate achievement
of both the generic and specialty specific HiLLOs throughout their training period.

Each HiLLO has an overarching description that describes what a specialist in Intensive Care Medicine will
be able to do by the end of the training programme. Underneath this are a set of key capabilities that are
examples of how an ICM trainee could evidence (in the ICM ePortfolio) attaining the required level of the HiLLO
at the different stages of training. All HiLLOs are mapped to the GPC framework. Every HiLLO also includes
examples of evidence that ICM trainees may use to support their achievement of the HiLLO, as well as
suggested assessment methods.

The key capabilities and examples of evidence are intended to provide a prompt to trainees and their trainers
as to how the overall outcomes may be achieved. They are not intended to be exhaustive and there are many
more examples that would provide equally valid evidence of performance. In addition, excellent ICM trainees
may produce a broader portfolio of evidence that demonstrates deeper learning. It is not expected that ICM
trainees will provide a set quota of evidence; the aim of assessment is to provide adequate, robust evidence
to demonstrate acquisition of the expected Level of each HiLLOs at each stage of training.

Satisfactory sign off for each stage of training requires demonstration that, for each of the HiLLOs, the ICM
trainee’s performance meets or exceeds the minimum requirements as described. This will require
Educational Supervisors to make a global judgement indicating whether satisfactory progress for the defined
stage of training has been made. More detail is provided in Section 6: Programme of Assessment.

4.4. Special Skills

Intensive Care Medicine has a history of practitioners from many different backgrounds bringing skills into the
Intensive Care Unit – these skills are of direct patient benefit and contribute to the construction of a
comprehensive team.

The GMC’s ‘Good Medical Practice’ requires doctors to commit to life-long learning in order to maintain and
improve performance; the foundations for this set of attitudes and behaviours must be established during
training through aspiration to excellence, manifest by the acquisition of special skills and interests.

During Stage 2, trainees will be expected to develop and consolidate expertise in a special skill directly relevant
to ICM practice. Areas of particular benefit to the future development of critical care and its work force are
recommended including ultrasound expertise, education or research.
The choice of special skill should be guided by discussion with the ICM Training Programme Director to reflect
the career intentions of the trainee. For example, a trainee intending to practice in a more remote area may
wish to develop greater ultrasound expertise as these skills may be required more regularly in such an
environment than in a large central hospital. Acquisition of this expertise must be as part of an FICM-
approved 15 training programme. Options include:

• Additional Medicine, Anaesthesia or Emergency Medicine

• Academic Research (may be standalone or as part of an academic training programme)

15
Full guidance documents for approved dual and triple CCTs specialties will be available on the FICM website

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 ICM Curriculum:
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• Augmented learning outcomes in specialist Intensive Care including Paediatric (via the subspecialty of
Paediatric Intensive Care Medicine), Cardiothoracic or Neurosurgical Intensive Care Medicine
• Echocardiography
• ECMO
• Home Ventilation
• Quality Improvement
• Transfer Medicine
• Education
• Subspecialty of Pre-Hospital Emergency Medicine

During these blocks, trainees must continue to develop their patient-orientated intensive care skills. Trainees
should continue with a substantial clinical workload (typically 75% of their time) to maintain and develop
clinical skills. This should include regular supervised daytime and out of hours work.

To view the learning outcomes for the Special Skills modules, see Annex B.

4.5. Local decisions about the training programme

The exact nature of each training programme will be decided at a regional level following discussion with the
Regional Advisor and local training leads. However, the overall programme must conform to the specifications
outlined in this document and deliver the training outcomes as defined in the Assessment Blueprint.

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5. Programme of Learning
5.1. The training programme
The organisation and delivery of postgraduate training is the responsibility of Health Education England (HEE),
NHS Education for Scotland (NES), Health Education and Improvement Wales (HEIW) and the Northern Ireland
Medical and Dental Training Agency (NIMDTA). A Training Programme Director will be responsible for
coordinating the ICM training programme in each Trust/Health Board. The local organisation and delivery of
training is overseen by a School – this is either a School of ICM or a joint School of Anaesthesia and ICM.

Progression through the programme will be determined by the Annual Review of Curriculum Progression
(ARCP) process (section 5.8) and the training requirements for each stage of training are summarised in the
ICM ARCP decision aid. The successful completion of each stage of training will be dependent on achieving
the expected level of attainment in all HiLLOs. The programme of assessment will be used to monitor and
determine progress through the programme. Training will normally take place in a range of settings, including
in district general hospitals and large teaching hospitals.

The sequence of training should ensure appropriate progression in experience and responsibility. The training
to be provided at each training site is defined to ensure that, during the programme, the entire syllabus is
covered and also that unnecessary duplication and educationally unrewarding experiences are avoided. The
sequence of training should be flexible enough to allow the ICM trainee to develop a special interest.

5.2. The training environment

This curriculum should be used to help design training programmes locally that ensure all Intensive Care
Medicine trainees can develop the necessary skills and knowledge in a variety of settings and situations. It is
designed to ensure that it can be applied in a flexible manner, meeting service needs as well as supporting
each doctor-in-training’s learning and development plan. The requirements for curriculum delivery have not
changed as a result of this new curriculum. All training must comply with the GMC requirements presented in
Promoting excellence: standards for medical education and training (2017) 16. This stipulates that all training
must comply with the following ten standards:

Theme 1: Learning environment and culture

S1.1 The learning environment is safe for patients and supportive for learners and educators. The
culture is caring, compassionate and provides a good standard of care and experience for
patients, carers and families.
S1.2 The learning environment and organisational culture value and support education and training,
so that learners are able to demonstrate what is expected in Good Medical Practice and to
achieve the learning outcomes required by their curriculum.

Theme 2: Educational governance and leadership

S2.1 The educational governance system continuously improves the quality and outcomes of
education and training by measuring performance against the standards, demonstrating
accountability and responding when standards are not being met.
S2.2 The educational and clinical governance systems are integrated, allowing organisations to
address concerns about patient safety, the standard of care, and the standard of education
and training.

16
GMC Promoting excellence: standards for medical education and training (2017)

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S2.3 The educational governance system makes sure that education and training is fair and is based
on the principles of equality and diversity.

Theme 3: Supporting learners

S3.1 Learners receive educational and pastoral support to be able to demonstrate what is expected
in Good Medical Practice, and to achieve the learning outcomes required by their curriculum.

Theme 4: Supporting educators

S4.1 Educators are selected, inducted, trained, and appraised to reflect their education and training
responsibilities.
S4.2 Educators receive the support, resources and time to meet their education and training
responsibilities.

Theme 5: Developing and implementing curricula and assessments

S5.1 Medical school curricula and assessments are developed and implemented so that medical
students are able to achieve the learning outcomes required for graduates.
S5.2 Postgraduate curricula and assessments are developed and implemented so that doctors in
training are able to demonstrate what is expected in Good Medical Practice, and to achieve the
learning outcomes required by their curriculum.

It is the responsibility of HEE and its local offices, NES, HEIW, and NIMDTA to ensure compliance with these
standards for ICM training, and to notify the FICM if further support is required in achieving this. Training delivery
must also comply with the requirements of the latest edition of the COPMeD’s, ‘A Reference Guide for
Postgraduate Specialty Training in the UK: ‘The Gold Guide’’. 17

5.3. Educational strategies

The curriculum describes educational strategies that are suited to work-based experiential learning and to
appropriate off-the-job education. The manner in which the training programme is organised to deliver such
training will vary between regions, depending on local facilities, and will need to be flexible enough to be
tailored to the individual trainee. However, the most important element of training is appropriately supervised
direct participation in the care of patients with a wide range of conditions, and there can be no substitute for
this approach. Training should therefore be structured to allow the trainee to be involved in the care of
patients with the full range of critical illness and related problems.

During the training programme the trainee must demonstrate increasing responsibility and capability across
the full range of practice expected of an independent ICM consultant specialist.

5.4. Teaching and learning methods

The curriculum will be delivered through a variety of learning experiences. Trainees will learn from practising
clinical skills appropriate to their level of training and to their attachment within the department. An
appropriate balance needs to be struck between work-based experiential learning, appropriate formal
education sessions away from the clinical area and independent self-directed learning. ICM is a specialty that
encompasses a huge range of clinical conditions and a significant number of practical skills, such that the
greater proportion of learning should be work-based experience.

17
COPMeD (2018) A Reference Guide for Postgraduate Specialty Training in the UK: “The Gold Guide” 8th Edition

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The curriculum indicates where particular learning methods or experiences are especially recommended.
However, it is for the trainee, Educational Supervisor and Training Programme Director to tailor the exact
balance of methods to the particular regional environment and trainee in the most suitable blended manner.
Trainees should have supervised responsibility for the care of patients. A guiding principle should be that the
degree of responsibility taken by the trainee will increase as capability increases. This means that the degree
of clinical supervision will vary as training progresses, with increasing clinical independence and responsibility
as the High-Level Learning Outcomes are achieved.

All trainees are adult learners and take responsibility for their own education. It is the responsibility of the
trainers to ensure adequate and appropriate educational opportunities are made available to the trainee. In
turn the trainee should be enthusiastic and pro-active in identifying their own gaps in knowledge, skills,
attitudes and behaviour. Trainees are expected to take advantage of all the formal and informal learning
opportunities provided by their training placements.

The following describes different learning opportunities that trainees are able to utilise and draws from the
AoMRC’s Medical Leadership Curriculum.

5.4.1. Practice-based experiential learning

Trainees spend a large proportion of time on workplace-based experiential learning during supervised clinical
practice in hospital settings. Learning involves closely supervised clinical practice until competence is
achieved. The learning environment includes wards, clinics, laboratories, simulated activities and meetings.
These more informal settings are valuable situations in which to develop leadership abilities, alongside
colleagues from other professions and fields of work. With increasing responsibilities and independence, the
trainee will take the lead for an area of work, ultimately integrating a range of abilities to finally deliver
consultant level practice.

5.4.2. Learning from feedback

Trainees learn from experience and this can be enhanced by reflecting on feedback from patients, carers,
and the public, as well as colleagues and other staff.

5.4.3. Learning with peers

There are many opportunities for trainees to learn with their peers. Local and regional postgraduate teaching
opportunities allow trainees at different phases of training to come together for group learning. Examination
preparation encourages the formation of self-help groups and learning sets.

5.4.4. Formal postgraduate education sessions

The content of formal postgraduate education sessions and access to other more formal learning
opportunities are determined by the local faculty of ICM education and will be based on the curriculum. There
are many opportunities throughout the year for formal teaching locally and at regional, national and
international meetings.

Where appropriate, formal teaching/meetings should include the multi-professional team. Access should also
be provided to key meetings within the service. Suggested activities include:

• a programme of formal ‘bleep-free’ regular teaching sessions to cohorts of ICM trainees

• attendance and presentation at mortality and morbidity meetings
• case presentations

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• research, audit and quality improvement projects

• attendance and presentation at governance and risk meetings
• lectures and small group teaching
• clinical skills demonstrations and teaching
• critical appraisal and evidence-based medicine and journal clubs
• joint specialty and multi-professional meetings
• attendance at training programmes organised on a deanery or regional basis that are designed to cover
aspects of the training programme outlined in this curriculum.

5.4.5. Formal study courses

Time to be made available for appropriate formal courses is encouraged, subject to local conditions of
service. Examples include life support, management and communication courses.

5.4.6. Simulation training

Simulation can provide a safe environment where a trainee can learn and practice procedural skills. Scenario-
based immersive simulation training can be used to develop teamworking and communication skills as well
as gaining experience in rare but potentially life-threatening clinical scenarios such as anaphylaxis and
cardiac arrest. It will also afford trainees the opportunity to practice multi-disciplinary teamworking.

5.4.7. Independent self-directed learning

ICM Trainees will use this time in a variety of ways depending upon their stage of learning. Suggested activities
include:

• reading, including web-based material such as e-Learning for Healthcare (e-LfH, e-ICM)
• maintenance of personal portfolio (self-assessment, reflective learning, personal development plan)
• audit, quality improvement and research projects
• reading journals
• achieving personal learning goals beyond the essential, core curriculum.

5.4.8. Specific trainer input

It is important to recognise and capitalise on the experience and expertise within each placement, including
non-clinical staff. Different members of the team can act as role models at different stages, including those
from other professions or spheres of work.

5.4.9. Supporting professional activities time for trainees

In order to facilitate the acquisition of the essential generic capabilities required for safe, effective and high
quality medical care as prescribed by the GMC’s GPC framework, and to recognise the contribution ICM
trainees make outside of the clinical setting, the FICM recommends that local Schools consider mechanisms
to enable and encourage trainee involvement in research, audit and quality improvement, as well as allowing
time for them to work on publications and presentations and participate in teaching and aspects of hospital
management.

5.5. Academic training

All ICM trainees are required to complete the requirements of HiLLO3; they should know how to ‘undertake
medical research including the ethical considerations, methodology and how to manage and interpret data
appropriately.’ ICM specialists are encouraged to participate in clinical research and collaborative trials to

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achieve the required outcomes, as well as in journal clubs, literature and systematic reviews, and to make
contributions to the publication of novel findings in peer-reviewed journals. Understanding of the principles of research,
its interpretation and the safe implementation of evidenced based new methods, processes and techniques is
essential for the modern, progressive practice of Intensive Care Medicine and in the interests of patients and the
service. An Academic Research SSY is additional to HiLLO 3, and has its own capabilities and levels.

ICM trainees may also train in academic ICM as an academic clinical fellow (ACF) or equivalent. Some ICM
trainees may opt to do research leading to a higher degree without being appointed to a formal academic
programme. This new curriculum should not impact in any way on the facility to take time out of programme
for research (OOPR) but as now, such time requires discussion between the ICM trainee, and/or
academic/research specialist, the TPD, and the Deanery as to what is appropriate, together with guidance
from the FICM that the proposed period and scope of study is sensible. ICM trainees following this route need
to complete all of the essential elements of the ICM curriculum satisfactorily in order to achieve certification.
The rate of progression through the clinical component of their training is determined by the ARCP process to
ensure that all clinical requirements are met in keeping with the curriculum.

The four nations have different arrangements for academic training and ICM trainees should consult their
local HEE office or Deanery for further guidance.

5.6. Out of hours commitments

Most ICM work is unscheduled and at least 50% of admissions to ICUs occur ‘out of hours’. In view of this, it is
essential for trainees to gain experience outside routine working hours.

The pattern of work undertaken during all stages of training must be compliant with relevant legislation and
contractual requirements and provide exposure to all aspects of clinical care. This specifically includes
working at night and weekends and reflects the different case mix admitted at different times of day. This
requirement provides:

• An opportunity to experience and develop clinical decision making, with the inevitable reduction in out-
of-hours facilities, under distant supervision.
• An opportunity to learn when to seek advice and appreciating that, when learning new aspects of
emergency work as trainees, they require close clinical supervision.
• A reflection of the expected working practices of an Intensive Care Medicine specialist who will regularly
admit emergency patients out of hours.

When working at night and weekends the trainee should principally be covering the area of clinical practice
consistent with their current stage of training. For example, during Stage 1, a trainee undertaking Anaesthesia
training is expected to provide cover for this area. Likewise, when working in ICM they should be providing cover
here. It is acceptable for the trainee to be involved in the management of patients outwith the specialty as
long as it is appropriate to the level of training and the care of other patients is not compromised e.g. a
trainee covering the ICU could be called to the ED as part of a trauma call but they must be able to return to
the unit if required.

Occasionally, there may be a unit of training, where out of hours work is not required; this will be the exception
and would only be suitable as a short-term placement.

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The Faculty does recognise that there are occasions when additional out of hours work is required due to
local circumstances; when this occurs, it should be for short periods only, otherwise there will be an adverse
impact on the trainee’s progression through the programme, making it is almost certain that training time will
have to be extended to ensure the learning outcomes are met.

Local trainers, in conjunction with their Clinical Directors, must recognise this consequence if excessive out of
hours commitments are placed above training requirements. Finally, it is important to ensure that any new
aspects of emergency work are undertaken initially with close clinical supervision.

For trainees unable to undertake out of hours work due to illness or other debilitating circumstances, the
Faculty Tutor, RA, TPD and FICM Training, Assessment and Quality Committee will determine whether it is
possible to obtain all the essential learning outcomes and if so, what, if any, additional training arrangements
will be required. This may involve extending the period of training for specific placements or indeed the whole
programme depending on the trainees’ opportunities to access the necessary training and their progress in
achieving the relevant outcomes. Trainees are advised to discuss the potential consequences of an inability
to perform out of hours work as soon as practicable, as it may have a major impact on the training
programme leading to the award of a CCT, including failure to complete a CCT programme.

5.7. ‘Acting Up’ as a consultant

Time spent in a Locum Consultant appointment does not count toward the CCT/CESR[CP]: only time spent in a
GMC approved training programme counts toward the CCT/CESR[CP]. It is recognised, however, that some
StRs towards the end of their training would benefit from being enabled to ‘act up’ in a consultant capacity
and undertake duties similar to those encountered in consultant practice. It is appropriate for a doctor in
training to act up in a consultant capacity providing that there are adequate arrangements for supervision,
albeit at a distance, to ensure that the quality of training is maintained. Stage 3 of the ICM Curriculum is ideally
placed to encourage this type of working, particularly towards the latter part of the training year.

The doctor will retain their NTN and continue to be supervised by and be responsible to the local Training
Committee. It is essential that at all times the StR has immediate access to consultant advice and
understands that they are still in training until completion of the CCT/CESR[CP].

Such a post can only occur when it is felt the doctor is suitably ready by the local trainers and on the proviso
that they have satisfactorily completed all other aspects of the ICM training programme.

If, however, the period of acting up as a consultant is not deemed to be a normal part of the ICM CCT training
programme and the StR still wishes this to count towards their CCT/CESR[CP], then prospective approval must
be sought from the GMC in the same way as other out of programme training, or it must be taken as Out of
Programme Experience. Please refer to COPMeD’s Gold Guide 18 for details.

18
COPMeD (2018) A Reference Guide for Postgraduate Specialty Training in the UK: “The Gold Guide” 8th Edition

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6. Programme of Assessment
6.1. Aims
• The FICM Programme of Assessment should allow learners to demonstrate they have met the outcomes
from the curriculum in a way that is fair and reproducible, using methods that both trainees and trainers
find useful and practical and that considers the available educational evidence base.
• It should prioritise patient safety whilst at the same time encourage excellence in training and
professional performance; assessment is a useful tool for learning not just for proof of learning.
o Formative assessments will be used as a tool to promote learning and encourage excellence.
o Summative assessments and judgements will make clear the scope of performance and
capabilities trainees have. This will ensure their skills reflect their level of clinical responsibility and
maintain patient safety.
• Whilst it must be clear how each HiLLO has been assessed, there should be no unnecessary repetition of
assessments with the overall burden of assessment being reduced whilst maintaining proportionality.
• Where there are key progression points in training, for example between stages of training, judgements
based on triangulation of evidence from a number of sources should be used to show trainees have
demonstrated suitable capability for their level of training. This protects patients and ensures trainees are
assessed fairly. Trainees should know what is expected of them at these key progression points.

6.2. Programme of assessment

The programme of assessment refers to the integrated framework of exams, assessments in the workplace
and judgements made about an ICM trainee during their approved programme of training. The purpose of
the programme of assessment is to robustly evidence, and clearly communicate the expected levels of
performance and ensure these are met on an annual basis and at other critical progression points in, and to
demonstrate satisfactory completion of, training as required by the curriculum. Detailed guidance will be
provided to assist trainers and trainees.

The programme of assessment comprises the use of a number of individual assessment tools. They are
already well established in ICM training, including both formative and summative assessments, and have
been selected on the basis of their fitness for purpose and their familiarity to trainees and trainers. These
include the summative FFICM examinations that encompass the ‘knowledge requirements’ that underpin the
entire curriculum. The syllabus for each component of the examinations is mapped to the curriculum
capabilities and HiLLOs. Other assessment tools are the formative Supervised Learning Events (SLEs), while the
MSF has both formative and summative roles.

A range of assessments is needed to generate the necessary evidence required for global judgements to be
made about satisfactory performance, progression in, and completion of, training. All assessments, including
those conducted in the workplace, are linked to the relevant HiLLOs (eg through blueprinting of the
assessment system to the stated curriculum outcomes).

The programme of assessment emphasises the importance and centrality of professional judgement in
making sure ICM trainees have met the expected level of attainment in the HiLLOs at each stage of training, as
set out in the approved curriculum. It also focuses on the Intensive Care Medicine doctor as a reflective
practitioner. Assessors will make accountable, professional judgements on whether progress has been made.
The programme of assessment explains how professional judgements are used and collated to support
decisions on progression and the satisfactory completion of training.

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ICM trainees will be assessed throughout the training programme, allowing them to continually gather
evidence of learning and to provide formative feedback. Those assessment tools which are not identified
individually as summative will contribute to summative judgements about a trainee’s progress as part of the
programme of assessment. The number and range of these will ensure a reliable assessment of the training
relevant to their stage of training and achieve coverage of the curriculum.

Reflection and feedback should be an integral component to all Supervised Learning Events. Every clinical
encounter can provide a unique opportunity for this. It should occur frequently and as soon as possible after
any event to maximise benefit for the trainee. Feedback should be of high quality and should include an
action plan for future development for the trainee. Both ICM trainees and trainers should recognise and
respect cultural differences when giving and receiving feedback.

6.3. The Fellowship of the Faculty of Intensive Care Medicine

The Fellowship of the Faculty of Intensive Care Medicine (FFICM) examinations will continue to be overseen by
the Examinations Committee and Examinations Department. No major planned changes to the content of the
examinations are expected as a result of this new curriculum as the syllabus remains unchanged.

The FFICM Final examination is taken during Stage 2 of the training programme. A successful pass is required
before progression to Stage 3 ICM training. Eligibility to sit the FFICM Final examination requires a pass in the
Primary examination of one of the defined core training programmes and completion of Stage 1 training.

The examination consists of three sections: the Multiple Choice Question (MCQ) examination, the Objective
Structured Clinical Examination (OSCE) and the Structured Oral Examination (SOE).

Full details of the examination and its component parts are contained in the FFICM Examination Regulations.

6.4. Assessment of High-Level Learning Outcomes

The assessment process contains both formative and summative elements that are detailed in section 6.7. All
assessments are reviewed by the panel at the Annual Review of Competence Progression (ARCP).

Formative assessment
Formative assessment is an assessment for learning. The goal of formative assessment is to monitor progress
in order to offer ongoing constructive feedback with the aim of improving performance. In formative
assessment there is no grade or mark, no pass or fail. Formative assessment must provide good quality
feedback; without this the process loses its purpose. The main formative assessments used in the curriculum
are Supervised Learning Events (SLEs).

SLEs provide only one source of evidence that a trainee has achieved the outcomes of a HiLLO. Their purpose
is to demonstrate engagement of trainers and trainees in professional educational conversations alongside
their logbook of procedures and consultant feedback. Further examples of how trainees might evidence
achievement of the High-Level Learning Outcomes are included in the ‘Evidence to Inform decision’ section
that accompanies each HiLLO. These will include activities such as teaching, course attendance and quality
improvement projects.

The ICM curriculum uses an outcomes-based curriculum. The key capabilities, listed underneath each HiLLO,
illustrate ways in which achievement of the HiLLO could be achieved.

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Summative assessment
Summative assessment is assessment of learning and results in a mark or grade, pass or fail. The goal of
summative assessment is to test knowledge or performance against set criteria. Full details of the above can
be found in the Assessment Strategy on the FICM website.

6.5. Critical Progression Points

There are three critical progression points during ICM training:

Critical progression point 1: End of Stage 1 (ST4)

To complete Stage 1 training successfully, the ICM trainee must have achieved all of the generic and specialty
HiLLOs for that stage of training. In signing the Stage One Training Certificate trainers must be satisfied that the
trainee has obtained the required level of achievement in all of the HiLLOs. If this is not the case the trainee
must spend more time in Stage 1 training. Satisfactory completion of Stage 1 is a prerequisite for eligibility for
entry to Stage 2 of the ICM training programme. A satisfactory ARCP outcome will be required for entry to
Stage 2 training (ST5-6).

Critical progression point 2: End of Stage 2 (ST6)

To complete Stage 2 training successfully, the ICM trainee must pass the FFICM Examination in its entirety, as
well as achieve all of the generic and specialty HiLLOs required for that stage of training. In signing the Stage
Two Training Certificate, trainers must be satisfied that the trainee has obtained the required level of
achievement in all of the HiLLOs. If this is not the case the ICM trainee must spend more time in training in
Stage 2. A satisfactory ARCP outcome will be required for entry to Stage 3 training (ST7).

Critical progression point 3: End of training (ST7)

The final progression point is at the end of training when ICM trainees will be required to demonstrate that
they have met the specified standard in all of the HiLLOs for the end of this final stage of training. Trainers must
be satisfied that this is the case and an ARCP outcome 6 will be required in line with issuing a Stage Three
Training Certificate so that an ICM trainee can apply for the award of a Certificate of Completion of Training
(CCT).

At all stages of training, the Educational Supervisor’s Structured Report (ESSR) will make a recommendation to
the ARCP panel as to whether the ICM trainee has met the required level of achievement in each of the HiLLOs
for each stage of training and, where relevant, the critical progression points. The ARCP panel will make the
final decision on whether the trainee has satisfactorily achieved the required standard and can therefore
progress to the next year or stage of training [see section 7.1].

6.6. High-Level Learning Outcomes Grid

The table below provides a high-level description of attainment to be achieved, in each of the HiLLOs, at the
end of each stage of training in order to progress to the next.

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Expected capability
HiLLO High-Level Learning Outcomes (HiLLOs) – level by end of:
Number Intensive Care Medicine Stage Stage Stage
1 2 3
The doctor will be able to function successfully within NHS organisational
1 and management systems whilst adhering to the appropriate legal and 2 3 4
ethical framework.
The doctor will be focused on patient safety and will deliver effective quality
2 improvement, whilst practising within established legal and ethical 2 4 4
frameworks.
An Intensive Care Medicine specialist will know how to undertake medical
3 research including the ethical considerations, methodology and how to 2 3 4
manage and interpret data appropriately.
To ensure development of the future medical workforce, a doctor working
4 as a specialist in Intensive Care Medicine will be an effective clinical 2 3 4
teacher and will be able to provide educational and clinical supervision.

Doctors specialising in Intensive Care Medicine can identify, resuscitate and

5 stabilise a critically ill patient, as well as undertake their safe intra-hospital 2 3 4
or inter-hospital transfer to an appropriately staffed and equipped facility.

Intensive Care Medicine specialists will have the knowledge and skills to
initiate, request and interpret appropriate investigations and advanced
monitoring techniques, to aid the diagnosis and management of patients
6 2 3 4
with organ systems failure. They will be able to provide and manage the
subsequent advanced organ system support therapies. This will include
both pharmacological and mechanical interventions.
Specialists in Intensive Care Medicine can provide pre-operative
resuscitation and optimisation of patients, deliver post-operative clinical
7 2 3 4
care including optimising their physiological status, provide advanced
organ system support and manage their pain relief.
Doctors specialising in Intensive Care Medicine will understand and
manage the physical and psychosocial consequences of critical illness for
patients and their families, including providing pain relief, treating delirium
8 and arranging ongoing care and rehabilitation. They will also manage the 2 3 4
withholding or withdrawal of life-sustaining treatment, discussing end of life
care with patients and their families and facilitating organ donation where
appropriate.
Intensive Care Medicine specialists will have the skillset and competence to
lead and manage a critical care service, including the multidisciplinary
9 2 3 4
clinical team and providing contemporaneous care to a number of
critically ill patients.

Intensive Care Medicine specialists will have developed the necessary skills
10 of induction of anaesthesia, airway control, care of the unconscious patient 2 3 3
and understanding of surgery and its physiological impact on the patient.

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Expected capability
HiLLO High-Level Learning Outcomes (HiLLOs) – level by end of:
Number Intensive Care Medicine Stage Stage Stage
1 2 3
In order to manage acutely ill patients outside the Intensive Care Unit, an
Intensive Care Medicine specialist will have the diagnostic, investigational
11 3 3 3
and patient management skills required to care for ward-based patients
whose condition commonly requires admission to the intensive care unit.
Doctors specialising in Intensive Care Medicine understand the special
needs of, and are competent to manage patients with neurological
12 diseases, both medical and those requiring surgery, which will include the 1 3 3
management of raised intracranial pressure, central nervous system
infections and neuromuscular disorders.
A specialist in adult Intensive Care Medicine is competent to recognise,
provide initial stabilisation and manage common paediatric emergencies
13 until expert advice or specialist assistance is available. They are familiar 1 3 3
with legislation regarding safeguarding children in the context of Intensive
Care Medicine practice.
Intensive Care Medicine specialists recognise the special needs of, and are
competent to provide the perioperative care to patients who have
14 undergone cardiothoracic surgery, including providing pain relief and 1 3 3
advanced organ system support utilising specialised techniques available
to support the cardiovascular system.

6.7. Evidence of progress

The following methods will provide evidence of progress in the integrated programme of assessment. The
requirements for each training year and Stage of training are stipulated in the Assessment Blueprint. Evidence
is a crucial concept in this curriculum and, as well as the methods listed below, can include other sources
such as the Personal Development Plan, quality improvement project or logbook summaries. The ICM trainee
will collect evidence to support their acquisition of the requirements for each of the HiLLOs, and the
Educational Supervisor will use it to make a global judgement indicating whether the trainee has made
satisfactory progress for the defined Stage of training. These methods are described briefly below. More
information and guidance for ICM trainees and trainers will be available in the ‘Assessment Guidance’.

Where possible, supervised learning events (SLEs) as formative assessments are favoured over assessments of
performance (summative assessments) to encourage depth of learning from experienced clinicians in the
clinical environment. The Multi-Source Feedback (MSF) tool is primarily formative yet has an important
summative role that contributes to the assessment of performance, the Educational Supervisor’s Structured
Report and the ARCP, and the Faculty has made clear the justification for this.

Use of formative assessments (supervised learning events) in the workplace, with a focus on trainee-trainer
discussion and reflection to guide learning in clinical scenarios, is encouraged to improve the validity and
acceptability of these tools for trainers and trainees. It is hoped these changes will drive excellence in
assessment and emphasise the value of input and guidance from senior clinicians.

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Where summative assessments or judgements are required for progression (for example written
examinations, an Educational Supervisor’s Structured Report (informed by a multisource feedback
assessment), or at the Annual Review of Competency Progression (ARCP)), this has been highlighted within the

programme of assessment (See Section 7: Progression and the Programme of Assessment). It is clear

how each assessment contributes to progression at these key points, and the recommended course of action
if these criteria are not met.

6.7.1. Summative assessment

Summative assessment is assessment of learning and results in a mark or grade, pass or fail. The goal of
summative assessment is to test knowledge or performance against set criteria. The summative assessments
in the Intensive Care Medicine training programme take the following forms:
• Fellowship of the Faculty of Intensive Care Medicine (FFICM) examination
• Stage 1 Training Certificate
• Stage 2 Training Certificate
• Stage 3 Training Certificate

6.7.2. Formative assessment

Formative assessment is assessment for learning. The goal of formative assessment is to monitor progress in
order to offer ongoing constructive feedback with the aim of improving performance. In formative assessment
there is no grade or mark, no pass or fail. Formative assessment must provide good quality feedback; without
this, the process loses its purpose.

The educational supervisor should review the SLE with the ICM trainee to see how they are progressing and to
ensure that they are acting on feedback received.

The main formative assessments used in the curriculum are the SLEs listed below:
• Mini-Clinical Evaluation Exercise [Mini-CEX]
• Acute Care Assessment Tool for Intensive Care Medicine [ACAT]
• Direct Observation of Procedural Skills [DOPS]
• Case based Discussion [CBD]
• Annual Multi-Source Feedback [MSF]
• Procedures log

6.7.3. Supervised Learning Events (SLEs)

Each individual SLE is designed to assess a range of important aspects of performance in different training
situations. Taken together they can assess the breadth of knowledge, skills and performance described in the
curriculum. The SLEs described in this curriculum have been in use for ten years and are now an established
component of training.

The SLE methodology is designed to meet the following criteria:

• Validity – the assessment actually does test what is intended; that methods are relevant to the actual
clinical practice; that performance in increasingly complex tasks is reflected in the assessment outcome
• Reliability – multiple measures of performance using different assessors in different training situations
produce a consistent picture of performance over time
• Feasibility – methods are designed to be practical by fitting into the training and working environment

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• Cost-effectiveness – the only additional significant costs should be in the training of trainers and the
time invested needed for feedback and regular appraisal, which should be factored into trainer job plans
• Opportunities for feedback – structured feedback is a fundamental component
• Impact on learning – the educational feedback from trainers should lead to ICM trainees’ reflections on
practice in order to address learning needs.

SLEs use different trainers’ direct observations of ICM trainees to assess the actual performance of Intensive
Care Medicine doctors as they manage different clinical situations in different clinical settings and provide
more granular formative assessment in crucial areas of the curriculum than does the more global
assessment provided by supervisors’ reports. SLEs are primarily aimed at providing constructive feedback to
trainees in important areas of the curriculum throughout each placement in all phases of training. It is normal
for ICM trainees to have some assessments that identify areas for development because their performance is
not yet at the standard for the completion of that training.

6.7.4. Number of assessments required and further guidance

It is recognised that trainers and trainees value guidance in terms of numbers of assessments required.
However, the total number of assessments completed is less important than the quality of the assessments
and breadth of cases covered. This allows Educational Supervisors to form reliable judgements of
performance. Therefore, there is no ‘target’ number, instead the Faculty have suggested the following
guidance:

• Each HiLLO must have appropriate evidence for the ES or CS to sign off at the appropriate level for
training. The ICM Assessment Blueprint highlights which forms of assessment are most appropriate for
each HiLLO. This may be supplemented by other evidence such as, amongst others, development
courses, teaching sessions, simulation and self-directed learning. However, where demonstration of
performance in practice is required, SLEs and the MSF are likely to form the highest quality of evidence
upon which an ES or CS can base their judgement.
• One assessment may be used to evidence multiple capabilities. However, it must be clear to anyone
reviewing such evidence that all capabilities linked were assessed and commented upon during the
assessment, and that the assessment tool used was appropriate to assess the capabilities linked.
• The ES/CS will provide guidance to individual trainees at supervisor meetings regarding the quality and
breadth of assessments completed. Trainees performing well will use assessments in a creative way to
demonstrate and improve their practice.
• The numbers of different types of SLE used may change as trainees progress through training. For
example, stage 3 trainees may choose to use the ACAT or CBD more than the DOPS or mini-CEX reflecting
that evidence of complex decision making and leadership skills may be more useful for learning than
observed clinical procedures by this stage of training.
• It will be necessary to complete multiple SLEs within the same capabilities over a period of time. For
example, multiple DOPS for complex procedures e.g. tracheostomy or emergency airway management
would be expected to be completed by different assessors over a period of time and followed by a
procedures log to demonstrate maintenance of skill. For more simple procedures this may not be
required.
• The procedures log is required to evidence maintenance of complex practical skills as described above.
However, there is insufficient evidence to support a required number of procedures. Instead, numbers
required will depend on the training level and the circumstances of the individual trainee. For example, the
ES/CS is more likely to require evidence of maintenance of advanced airway skills from trainees that are
undertaking part of their training in areas where these skills are not used regularly.

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6.7.5. Who can assess?

Consultants, specialty Intensive Care Medicine doctors, senior ICM trainees, Advanced Critical Care
Practitioners and senior nursing staff can facilitate SLEs providing they are competent to do so and
understand their role in facilitating the SLE in particular, the need for timely and constructive feedback. In
accordance with GMC standards assessors must possess expertise in the area to be assessed and be familiar
with the assessment process. Senior ICM trainees and non-medical staff may assess SLEs if they have
completed appropriate training and if the educational supervisor (ES) considers it appropriate for the level of
trainee being assessed. The ES may need to enter the assessment in the ePortfolio.

6.7.6. The Supervised Learning Event (SLE) process

Listed below are a few key points regarding SLEs:
• feedback is the most important element of an SLE
• ICM trainees should aim to undertake SLEs relevant to their current unit of training
• areas for assessment should be identified by the ICM trainee in discussion with their Educational
Supervisor
• requesting assessments retrospectively is considered bad practice and is not acceptable, except in
Case-Based Discussions
• the trainee should reflect on the learning event in the SLE
• the trainer should observe the performance of the ICM trainee, and give immediate verbal feedback, as
well as suggestions for future development, further reading etc.; they will indicate what level of supervision
the trainee requires for that activity
• trainers should comment on clinical and non-clinical aspects of performance, such as professionalism
and team-working
• if facilities exist, and it is safe to do so, the assessment can be documented on the ICM ePortfolio at this
time; this is the ideal situation
• if the online form cannot be completed at this time, the ICM trainee will send a request for assessment to
the trainer electronically
• verbal feedback should always take place at the time of the assessment
• the trainer should complete the online form as soon as possible
• linking the assessment to more than one unit of training may be appropriate

6.7.7. Supervisor reports

Consultant feedback, and feedback from other approved trainers, is an important source of evidence when
assessing trainees’ performance. This means of assessment is valuable in identifying ICM trainees who are
performing above or below the standard expected for their Stage of training.

All of these methods are described briefly below and include feedback opportunities as an integral part of the
programme of assessment. Assessment should be recorded in the ICM trainee’s ePortfolio. More information
and guidance for ICM trainees and trainers will be available in the ‘Guide to Intensive Care Medicine Training’.

6.7.8. FFICM
The FFICM examination is a three-part national assessment and comprises three sections: A Multiple-Choice
Question (MCQ) examination, an Objective Structured Clinical Examination (OSCE) and the Structured Oral
Examination (SOE). Each section is marked separately and does not influence the marks in any of the other
sections. Its major focus is on the knowledge required for practice but the structured oral examination and

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objective structured clinical examination test decision-making, understanding of procedure and practical
elements (including the use of simulation).

The FFICM examination must be successfully completed in order to progress to Stage 3 (ST7).

Further details on the examinations are available on the Examinations pages of the FICM website.

6.7.9. Stage 1 Training Certificate

The Stage 1 Training Certificate signifies that an ICM trainee has achieved the required level of attainment in all
HiLLOs for that Stage of training and is eligible to progress to Stage 2.

6.7.10. Stage 2 Training Certificate

The Stage 2 Training Certificate signifies that an ICM trainee has achieved the required level of attainment in
all HiLLOs for that Stage of training, has passed the FFICM Examination, and is eligible to progress to Stage 3.

6.7.11. Stage 3 Training Certificate

The Stage 3 Training Certificate signifies that an ICM trainee has achieved the required level of attainment in
all HiLLOs for that stage of training and is eligible to be awarded a Certificate of Completion of Training (CCT).

6.7.12. Case-based Discussion (CBD)

The CBD is intended to highlight learning within areas of clinical decision making and reasoning. Trainees
should pick cases that presented challenges, doubt or difficulty to maximise the usefulness of the assessment.
A review of the trainee’s documentation should be carried out. Feedback should be given at the time of the
case and documented contemporaneously. The CBD may also be useful for assessing more generic
knowledge and skills required for practice by focussing on different aspects of a case e.g. teamwork, safety,
evidence-based practice etc.

6.7.13. Direct Observation of Procedural Skills (DOPS)

The DOPS tool is an assessment of practical skills and ability. The assessor directly observes the trainee undertaking
a practical procedure and assesses their performance and gives feedback directly after the event.
Documentation of the encounter should include suitable context and detail for the ES or CS to establish the
complexity of the case and level of supervision deemed to be required using the capability level descriptors.

6.7.14. Mini-Clinical Evaluation Exercise (Mini-CEX)

The Mini-CEX is used to assess a trainee’s performance in clinical encounters with patients. It involves the
assessor directly observing a trainee in a clinical situation e.g. admission clerking or resuscitation. It is designed
to assess a variety of skills such as history taking, examination, communication skills and clinical judgement.

6.7.15. Acute Care Assessment Tool (ACAT)

The ACAT assesses the trainee’s ability to manage a body of work over a more extended period of time, better
reflecting their performance in practice. In the ICM environment, this will usually be during a rostered clinical
duty period and the assessment may focus on a variety of areas including leadership, time management and
prioritisation, team working and handover.

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6.7.16. Multi-Source Feedback (MSF)

The MSF allows trainees to collect feedback on performance from a variety of members of the healthcare
team. It collates the judgement of assessors from different groups: peers, senior clinicians, nursing staff, allied
healthcare professionals and clerical staff. These judgements are important; team-working, communication,
accessibility and trustworthiness are key aspects of the practice of the Intensive Care Medicine clinician and
are not assessed objectively via other assessment modalities in the same way.

12-15 or more assessors are required from a representative selection and a range of seniorities of the above
team members to complete the MSF. This number of assessors provides a reliable assessment of
communication, teamworking and trustworthiness. The Educational Supervisor will ensure that an adequate
number and breadth of assessor background and seniority is chosen and will review the evidence of
performance. A minimum of 4 senior permanent medical staff is expected. The MSF results are anonymously
presented after review by the ES, ensuring that feedback is presented in a constructive manner.

The MSF tool is predominantly formative, but does significantly inform the summative decisions that the
Educational Supervisor and ARCP panels will be required to make each year regarding progression. The
summative aspect relates to how the overall performance of the trainee (satisfactory or unsatisfactory) is
viewed by the whole of the MSF process, and whether it has been conducted in accordance with guidance on
numbers and suitable respondents. Each assessor will be asked to mark the components of the MSF as being
satisfactorily met or otherwise. The tool reflects the importance of adequate communication and team-
working skills within the clinical environment for patient safety. If performance is unsatisfactory, the trainee is
able to discuss areas for improvement and repeat the assessment but progression to the next stage of
training is unlikely to be judged permissible by the Educational Supervisor and ARCP panel until adequate
performance has been demonstrated utilising the MSF assessment.

The MSF adds value compared to judgements in these areas by clinicians only; different team members
provide a different perspective on professional practice. Furthermore, the MSF is the only assessment in the
workplace that is predictive of doctors in difficulty and so a trainee encountering difficulty with this
assessment should highlight to the ES that further attention is required in training and a shared action plan
can then be agreed.

6.7.17. Educational Supervisor’s Structured Report (ESSR)

The ESSR will annually record a longitudinal, global report of an ICM trainee’s progress based on a range of
assessments, potentially including exams and observations in practice or reflection on behaviour, by those
who have the appropriate expertise and experience. The ESSR can incorporate commentary or reports from
longitudinal observations, such as from supervisors or formative assessments, demonstrating progress over
time.

Its content must reflect the learning agreement and objectives established at the initial appraisal meeting.
There must be appropriate supporting evidence available to the Educational Supervisor (ES) and this must be
clearly documented in the report. If there has been any modification to the initial learning agreement during
the relevant period of training, the reasons for this must be included.

The Gold Guide stipulates the minimum standard required but it is important to include other evidence to
encourage and promote excellence. Logbooks, Quality Improvement progress reports, research and
publications are assessments of experience and are valid records of progress. The ES should be able to
suggest an appropriate outcome having reviewed and checked the documentation. The report must be

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discussed with the trainee prior to submission so that they are aware of any concerns regarding their training
progress, and trainees will receive feedback as part of the ARCP process.

6.7.18. Capability level descriptors

Whilst the Faculty recognise the value of Entrustable Professional Activities (EPAs), rather than introducing a
new assessment, we have further developed the existing use of capability levels (formerly competence levels)
to define the level of capability required for progression within each area of practice at the three stages of the
ICM training programme. It is felt that this similarly defines when entrustment decisions are made.

Clarification of the expected capability levels for each stage of training allows trainees to know what level of
performance is expected of them and what level of supervision is required within specific areas of practice as
trainees progress through training. It is a core component of the assessment strategy and the target
capability levels for each stage of training that are detailed in the HiLLOs Grid in this document.

Each capability level has construct-aligned descriptors; narrative scales guide trainees and trainers as to the
level of capability expected. These are anchored to real world practice and suggest the degree of
entrustability associated with each level (e.g. requiring direct supervision through to independent practice) –
see the table below.

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Capability level descriptors with construct-aligned anchors

Task orientated Knowledge orientated Patient management

Level
capability capability capability
Can take history, examine and arrange
Very limited knowledge; investigations for straightforward case (limited
Performs task under direct requires considerable differential diagnosis). Can initiate emergency
1
supervision. guidance to solve a problem management and continue a management
within the area. plan, recognising acute divergences from the
plan. Will need help to deal with these.
Performs task in Sound basic knowledge; Can take history, examine and arrange
straightforward requires some guidance to investigations in a more complicated case.
circumstances, requires help solve a problem within the Can initiate emergency management. In a
2
for more difficult situations. area. Will have knowledge of straightforward case, can plan management
Understands indications and appropriate guidelines and and manage any divergences in short term.
complications of task. protocols. Will need help with more complicated cases.
Performs task in most
circumstances, will need some Advanced knowledge and Can take history, examine and arrange
guidance in complex understanding; only requires investigations in a more complex case in a
situations. Can manage most occasional advice and focused manner. Can initiate emergency
3
complications, has a good assistance to solve a problem. management. In a most cases, can plan
understanding of Will be able to assess evidence management and manage any divergences.
contraindications and critically. May need specialist help for some cases.
alternatives.

Independent (consultant)
4 Expert level of knowledge. Specialist.
practice.

Educational Supervisors (ESs) will collate evidence from multiple sources to make overall judgements as to a
trainee’s level of capability and therefore their devolved responsibilities and required level of supervision. This
judgement is recorded via a capability level scored for each HiLLO via the ePortfolio. This helps to ensure
trainees have the appropriate skills and level of supervision at each Stage of training and thereby embeds
prioritisation of public safety within the programme of assessment.

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7. Training progression and the ARCP process

7.1. Progression and the Programme of Assessment
The FICM programme of assessment (see the table below) summarises the assessments that are required for
trainees to transition through the three main progression points (from Stage 1 to Stage 2, from Stage 2 to
Stage 3, and from Stage 3 to completion of training).

The target capability levels for each stage of training (see HiLLOs Grid) should be used alongside this to ensure
the level of capability and entrustment within each area (as judged by the Educational Supervisor and ARCP
panel) is sufficient to allow progression to the next stage of training.

The FICM Programme of Assessment

Stage 1 (ST3/4) Stage 2 (ST5/6) Stage 3 (ST7)

Supervised Learning Events (formative assessments)

CBD Adequate breadth and quality of assessments must be conducted to allow trainers to
make valid judgements of the doctor’s performance across all areas of the curriculum
MiniCEX
(see the ICM Assessment Blueprint).
DOPS The focus should be on the quality of feedback and evidence of learning from the
assessment. The emphasis is on the quality of assessment rather than numbers, and
ACAT
incorporating feedback from multiple assessors. Not pass/fail.

MSF 1 per year 1 per year 1 per year

Assessments of Performance (summative assessments)

Satisfactory completion of these assessments as judged by Educational Supervisor
is compulsory to allow progression
End of Stage Training Certificates
Stage 2 Training
Training Certificates Stage 1 Training Certificate Stage 3 Training Certificate
Certificate
Examinations
FFICM MCQ Required for progression
FFICM OSCE/SOE Required for progression
Capability levels
Doctors must have met the required capability levels for each HiLLO for stage of
training as indicated by the capability blueprint (see the HiLLOs Grid) and evaluated by
ES to progress to the next stage of training or to the award of CCT. Educational
Supervisors will not be able to complete these without sufficient evidence (e.g.
adequate numbers, variety and quality of SLEs, a diverse educational portfolio and
logbook of procedures). For doctors who are mid-stage, then the requirement is to
demonstrate engagement with spiral learning and progression in all the HiLLOs, without
necessarily reaching the required capability level for the end of stage.
Capabilities (see Meets requirements for Meets requirements for Meets requirements for
blueprint) stage of training stage of training stage of training
Other Requirements for progression / ARCP
A logbook of procedures performed relevant to stage of training and experience is
Procedures log
required for each year of training
ES Structured Report Satisfactory report for each year of training required for progression

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 ICM Curriculum:
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ES/CS End of Satisfactory End of Placement Report for each ICM Programme Placement during the
Placement Reports year

NB: Specific Statutory Education Bodies (SEBs) may require additional evidence, such as Form R

7.2. Assessments within complementary specialties or special skills years

Guidance from the programme of assessment relates to years during ICM training within an ICM placement.
Assessment guidance for Special Skills Years forms an integral part of each Special Skills requirements as
approved by the General Medical Council and is detailed in Annex B.

Assessment of trainees undertaking placements in the complementary specialties of Internal Medicine and
Anaesthesia will align to that of trainees undertaking Year 1 of training in that specialty. The programme of
assessment and the ARCP requirements for an ICM trainee will be matched to that of a Year 1 trainee in that
specialty.

7.3. The ARCP

The purpose and conduct of the ARCP is described in the Gold Guide.

‘4.38 The ARCP provides a formal process that reviews the evidence presented by the trainee and their
educational supervisor relating to the trainee’s progress in the training programme. It enables the trainee,
the Postgraduate Dean and employers to document that the capabilities/competences required are
being gained at an appropriate rate and through appropriate experience.’

Hence, the ARCP is an assessment of the documentary evidence submitted by the trainee. This should include,
as a minimum, a review of the trainees’ portfolio in the form of a structured report from the Educational
Supervisor (an ESSR). Assessment of the trainee usually occurs in the workplace and nationally in the form of
college/faculty examinations. The outcome of these assessments should be contained in the portfolio.

Appraisal and annual planning are separate processes but can be combined with the ARCP as long as the
outcome of the panel is decided prior to seeing the trainee. We would encourage the ES to make a
recommendation to the panel in their structured report.

7.4. Trainees requiring additional support

Doctors in training can encounter either personal or professional problems that may affect their performance.
With the introduction of personal development plans, appraisal, annual assessment, learning agreements and
clinical governance, trainees who struggle to achieve their goals within the expected timescale can be more
easily identified and may require support during their career. Whatever the reason for difficulty it should be
identified as early as possible. If the problems identified are related to attitudes and behaviours, the use of
non-technical skills assessment and targeted training may be required. Guidance for ICM trainees who have
not passed the FFICM examinations is available on the Examinations pages of the FICM website.

Any difficulties should feed into the appraisal process, via the Educational Supervisor’s Structured Report and
the MSF. Intensive Care Medicine doctors-in-training should be aware that the outcome of meetings with their
clinical and educational supervisors will, with their knowledge, help inform the assessment process and
therefore the ARCP panel; such discussions should be recorded. If local trainers are unable to remedy the
situation, the ARCP panel must be made aware, via the Educational Supervisor’s Structured Report, so that

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 ICM Curriculum:
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directed learning objectives can then be set. Help might involve a combination of extra supervision,
counselling or focused training. Those involved in the review should take account of any relevant external
factors which may have affected progress in training.

For those not progressing as expected, additional help and support must be given to enable them to fulfil the
requirements of the programme. Deaneries/NIMDTA will have a clear strategy for dealing with such situations
encompassing the spectrum of performance difficulties. Depending on the level of risk, the Educational
Supervisor will require a variable degree of support. It is highly recommended that all those involved in the
education and clinical supervision of trainees are aware of their local strategy to ensure appropriate support
can be provided to the trainee and that patient safety is maintained. In situations where trainees appeal
against assessment or other decisions, and informal resolution is not possible, then the process described in
the Gold Guide will be followed. 19

19
https://www.copmed.org.uk/gold-guide-8th-edition/

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7.5. ICM Assessment Blueprint

SLEs and MSF FFICM Examinations

HiLLO ES
High-Level Learning Outcomes (HiLLOs)
Number ACAT CBD Mini-CEX DOPS MSF Report MCQ OSCE SOE

The doctor will be able to function successfully within NHS

1 organisational and management systems whilst adhering √ √ √ √ √ √
to the appropriate legal and ethical framework.

The doctor will be focused on patient safety and will deliver

2 effective quality improvement, whilst practising within √ √ √ √ √ √ √ √
established legal and ethical frameworks.

An Intensive Care Medicine specialist will know how to

undertake medical research including the ethical
3 √ √ √ √ √ √
considerations, methodology and how to manage and
interpret data appropriately.

To ensure development of the future medical workforce, a

doctor working as a specialist in Intensive Care Medicine will
4 √ √ √ √ √
be an effective clinical teacher and will be able to provide
educational and clinical supervision.

Doctors specialising in Intensive Care Medicine can identify,

resuscitate and stabilise a critically ill patient, as well as
5 √ √ √ √ √ √ √ √
undertake their safe intra-hospital or inter-hospital transfer
to an appropriately staffed and equipped facility.

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SLEs and MSF FFICM Examinations

HiLLO ES
High-Level Learning Outcomes (HiLLOs)
Number ACAT CBD Mini-CEX DOPS MSF Report MCQ OSCE SOE

Intensive Care Medicine specialists will have the knowledge

and skills to initiate, request and interpret appropriate
investigations and advanced monitoring techniques, to aid
the diagnosis and management of patients with organ
6 √ √ √ √ √ √ √ √
systems failure. They will be able to provide and manage
the subsequent advanced organ system support therapies.
This will include both pharmacological and mechanical
interventions.
Specialists in Intensive Care Medicine can provide pre-
operative resuscitation and optimisation of patients, deliver
7 post-operative clinical care including optimising their √ √ √ √ √ √ √ √
physiological status, provide advanced organ system
support and manage their pain relief.
Doctors specialising in Intensive Care Medicine will
understand and manage the physical and psychosocial
consequences of critical illness for patients and their
families, including providing pain relief, treating delirium and
8 √ √ √ √ √ √ √ √
arranging ongoing care and rehabilitation. They will also
manage the withholding or withdrawal of life-sustaining
treatment, discussing end of life care with patients and their
families and facilitating organ donation where appropriate.

Intensive Care Medicine specialists will have the skillset and

competence to lead and manage a critical care service,
9 √ √ √ √ √ √ √
including the multidisciplinary clinical team and providing
contemporaneous care to a number of critically ill patients.

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 ICM Curriculum:
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SLEs and MSF FFICM Examinations

HiLLO ES
High-Level Learning Outcomes (HiLLOs)
Number ACAT CBD Mini-CEX DOPS MSF Report MCQ OSCE SOE

Intensive Care Medicine specialists will have developed the

necessary skills of induction of anaesthesia, airway control,
10 √ √ √ √ √ √ √
care of the unconscious patient and understanding of
surgery and its physiological impact on the patient.

In order to manage acutely ill patients outside the Intensive

Care Unit, an Intensive Care Medicine specialist will have the
11 diagnostic, investigational and patient management skills √ √ √ √ √ √ √ √ √
required to care for ward-based patients whose condition
commonly requires admission to the intensive care unit.

Doctors specialising in Intensive Care Medicine understand

the special needs of, and are competent to manage
patients with neurological diseases, both medical and
12 √ √ √ √ √ √ √ √
those requiring surgery, which will include the management
of raised intracranial pressure, central nervous system
infections and neuromuscular disorders.
A specialist in adult Intensive Care Medicine is competent to
recognise, provide initial stabilisation and manage
common paediatric emergencies until expert advice or
13 √ √ √ √ √ √ √ √
specialist assistance is available. They are familiar with
legislation regarding safeguarding children in the context of
Intensive Care Medicine practice.

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 ICM Curriculum:
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SLEs and MSF FFICM Examinations

HiLLO ES
High-Level Learning Outcomes (HiLLOs)
Number ACAT CBD Mini-CEX DOPS MSF Report MCQ OSCE SOE

Intensive Care Medicine specialists recognise the special

needs of, and are competent to provide the perioperative
care to patients who have undergone cardiothoracic
14 √ √ √ √ √ √ √ √
surgery, including providing pain relief and advanced organ
system support utilising specialised techniques available to
support the cardiovascular system.

FFICM Examination question banks will be reviewed and mapped to the new ICM HiLLOs.

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 ICM Curriculum:
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7.6. Special Skills Modules Assessment Blueprint

SLEs and MSF SSY Specific Tools

ES
SSY Modules Aims Mini- SSY Unique Logbook
ACAT CBD DOPS MSF Report Notes
CEX Assessments requirement*
Equip individuals with the
competencies to deliver
multicentre clinical research
Requires proof of completion of
within their critical care units
Academic PbD application for funding, GCP
following appointment as √ √ √ √
Research Viva Voce certificate, presentation at
NHS consultants, and also
national research meeting
initiate local research, if
individual aspirations and
local resources support this
Equip individuals with the
Additional training in
Cardiothoracic competencies required to Simulation
echocardiography is
Intensive Care work as a consultant in a √ √ √ √ √ √ (where
encouraged but not assessed as
Medicine specialist cardiothoracic available)
part of this SSY
intensive care unit
To train an individual to
echocardiography
competence at either: BSE Completion of
Completion of the MCQ
Level II ACCE (critical care BSE level 1 or 2 √*
examination (for level 2) or
echocardiography) or BSE requires a *requirements
practical assessment (level 1/2) is
Echocardiography Level I accreditation and to √ √ √ √ √ √ formal practical vary between
not required for progression
equip an individual with the assessment Level I and Level II
providing the learning outcomes
knowledge, skills and held by the BSE BSE accreditation
have been met
attitudes to be clinical lead - see notes
for echocardiography on a
critical care unit

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SLEs and MSF SSY Specific Tools

ES
SSY Modules Aims Mini- SSY Unique Logbook
ACAT CBD DOPS MSF Report Notes
CEX Assessments requirement*
√
To equip an individual with Logbook of
ECMO (Extra-
the knowledge and skills to Simulation procedures
Corporeal
provide ECMO as part of a √ √ √ √ √ √ (where (mandated
Membrane
team in a specialist Critical available) number for
Oxygenation)
Care Unit completion of
SSY)
Patient
To train an individual in the
satisfaction
management of patients
Home survey*
with respiratory failure who √ √ √ √ √ √
Ventilation *(either GMC or
require domiciliary ventilatory
BTS approved
support.
tool)
Consultant Intensive Care
Medicine doctors with
subspecialty training in NICM
have a central role in neuro
intensive care units. They share
the ultimate responsibility of care
with the admitting clinical teams
Simulation
Neuro Intensive and they collaboratively lead the
√ √ √ √ √ √ (where
Care Medicine provision of neuro intensive care,
available)
coordinating a multi-specialty
team of physicians, surgeons
and allied health professionals
including specialised nurses,
physiotherapists,
neurophysiologists and clinical
scientists.

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SLEs and MSF SSY Specific Tools

ES
SSY Modules Aims Mini- SSY Unique Logbook
ACAT CBD DOPS MSF Report Notes
CEX Assessments requirement*
To allow a doctor who is
unsuccessful in securing
appointment to the PICM
sub-specialty or who does
not wish to specialise in PICM,
This would facilitate a level of
the opportunity to further
capability commensurate with
develop the depth and
Paediatric being the paediatric ICM Lead in
breadth of their paediatric
Intensive Care √ √ √ √ √ √ a non-specialist hospital but
ICM skills. This would facilitate
Medicine would not equip the doctor as a
a level of capability
PICM specialist recognised by
commensurate with being
the GMC
the paediatric ICM Lead in a
non-specialist hospital but
would not equip the doctor
as a PICM specialist
recognized by the GMC
Intensivists with appropriate
prior expertise may apply via
Pre-Hospital
competitive national
Emergency See IBTPHEM curriculum
application for PHEM sub-
Medicine
specialty training (via
IBTPHEM)

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SLEs and MSF SSY Specific Tools

ES
SSY Modules Aims Mini- SSY Unique Logbook
ACAT CBD DOPS MSF Report Notes
CEX Assessments requirement*
This module covers the
competences required to
adopt a logical, scientific and
analytical approach to
quality improvement. It Although further professional
Quality encourages the accreditation (e.g. FMLM
Improvement in development of leadership √ √ √ √ √ √ fellowship) is encouraged, it is √
Healthcare skills to allow trainees a not a requirement for
platform to influence change completion of the year
in future practice. It aims to
develop expertise to share
with other members of the
healthcare team.
This module covers the
competences required to
make transfer decisions,
select the most appropriate An audit of transfer standards
transport platform, provide locally or at a regional or network
Transfer Intensive safe, effective and focused level is required. A number of
√ √ √ √ √ √
Care Medicine in-transit critical care and relevant courses / accreditations
ensure that the patients’ may be beneficial but not
condition and immediate required e.g. CCAT, DipIMC
needs are communicated to
receiving hospital clinical
staff.

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 ICM Curriculum:
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SLEs and MSF SSY Specific Tools

ES
SSY Modules Aims Mini- SSY Unique Logbook
ACAT CBD DOPS MSF Report Notes
CEX Assessments requirement*
This special skills module is
intended for trainees who are
considering developing a special
interest in medical education in
their consultant career. It intends
to further a trainee’s professional Peer-observed
Education development as an educator √ √ √ √ √ √ teaching
through taking part in a wide practice
variety of educational activities,
self-evaluation and utilising
frameworks in which to describe
their own development as a
trainer.

* SSY specific logbook requirement – The SSY modules that require a specific logbook are identified above but please note that as these modules fall within stage 2 of ICM training,
the standard curriculum requirements still apply and that includes maintaining a logbook of clinical procedures as a minimum.

Abbreviations: ACCE: Adult Critical Care Echocardiography

BSE: British Society of Echocardiography

BTS: British Thoracic Society
CCAT: Clinical Considerations in Aero Medical Transport
DipIMC: Diploma in Immediate Medical Care
ECMO: Extra-Corporeal Membrane Oxygenation
FMLM: Faculty of Medical Leadership and Management
GMC: General Medical Council
IBTPHEM: Intercollegiate Board for Training in Pre-Hospital Emergency Medicine
NICM: Neuro Intensive Care Medicine
PbD: Project based Discussion

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8. Supervision and feedback

This section of the curriculum describes how ICM trainees will be supervised, and how they will receive
feedback on performance. For further information please refer to the Academy of Medical Royal Colleges’
(AoMRC) guidance, ‘Improving feedback and reflection to improve learning.’ 20

Access to high-quality, supportive and constructive feedback is essential for the professional development of
the ICM trainee. Trainee reflection is an important part of the feedback process and exploration of that
reflection with the trainer should ideally be a two-way dialogue. Effective feedback is known to enhance
learning and combining self-reflection to feedback promotes deeper learning.

Trainers should be supported to deliver valuable and high-quality feedback. Senior ICM trainees would also
benefit from such training as they frequently act as assessors to more junior colleagues, and all involved
could also be shown how best to carry out and record reflection.

8.1. Supervision
All elements of work in training posts must be supervised with the level of clinical supervision varying
depending on the experience of the ICM trainee and the clinical exposure and case mix undertaken. As
training progresses the ICM trainee should have the opportunity for increasing autonomy, consistent with safe
and effective care for the patient.

Organisations must make sure that each ICM trainee has access to a named clinical supervisor and a named
educational supervisor. The role and responsibilities of supervisors have been defined by the GMC in their
standards for medical education and training 21.

8.1.1. Educational Supervisor (ES)

The educational supervisor is responsible for the overall supervision and management of a doctor’s
educational progress during a placement or a series of placements. They regularly meet with the doctor in
training to help plan their training, review progress and achieve agreed learning outcomes. They are also
responsible for the educational agreement, and for bringing together all relevant evidence to form a
summative judgement about progression at the end of the placement or a series of placements.

8.1.2. Clinical Supervisor (CS)

Day to day clinical supervision is provided by the duty consultant to whom the trainee is clinically responsible;
this is different to the concept of a Clinical Supervisor (as the GMC defines the role).

In specific units of training (eg Medicine, Anaesthesia, specialty ICUs), a named clinical supervisor oversees the
trainee’s clinical work throughout the specific placement. The clinical supervisor leads on reviewing the
trainee’s clinical or medical practice throughout the placement and contributes to the Educational
Supervisor’s Structured Report on whether the doctor should progress to the next stage of their training.

The clinical and educational supervisors, when meeting with the ICM trainee, should discuss issues of clinical
governance, risk management and any untoward clinical incidents involving the trainee. If there are any
concerns about the performance of an ICM trainee, or there are issues of doctor or patient safety, these will
be discussed with the relevant clinical and educational supervisors.

20
AoMRC Improving feedback and reflection to improve learning
21
GMC Promoting excellence: standards for medical education and training (2017)

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Educational and clinical supervisors need to be formally recognised by the GMC to carry out their roles. It is
essential that training in assessment is provided for trainers and ICM trainees in order to ensure that there is
complete understanding of the assessment system, assessment methods, their purposes and use. Training will
ensure a shared understanding and a consistency in the use of the SLEs and the application of standards.

Opportunities for feedback to ICM trainees about their performance will arise through the use of the SLEs,
regular appraisal meetings with supervisors, other meetings and discussions with supervisors and colleagues
as well as feedback from ARCP.

8.1.3. ICM Trainees

ICM trainees should make the safety of patients their first priority. Furthermore, they should not be practising in
clinical scenarios which are beyond their experiences and competences without supervision.

ICM trainees should actively devise individual learning goals in discussion with their trainers and should
subsequently identify the appropriate opportunities to achieve these learning goals. ICM trainees need to plan
their SLEs accordingly to enable them to collectively provide a picture of their development during a training
period. ICM trainees should actively seek guidance from their trainers in order to identify the appropriate
learning opportunities and plan the appropriate frequencies and types of SLEs according to their individual
learning needs. It is the responsibility of ICM trainees to seek feedback following learning opportunities and
SLEs. ICM trainees should self-reflect and self-evaluate regularly with the aid of feedback. Furthermore, they
should formulate action plans with further learning goals in discussion with their trainers.

8.2. Appraisal
A formal process of appraisals and reviews underpins training. This process ensures adequate supervision
during training, provides continuity between posts and different supervisors and is one of the main ways of
providing feedback to trainees. All appraisals should be recorded in the ICM ePortfolio.

8.2.1. Induction appraisal

The ICM trainee and Educational Supervisor should have an appraisal meeting at the beginning of each
placement to review the trainee’s progress so far (including the previous ESSR), agree learning objectives for
the post ahead and identify the learning opportunities presented by the post. Reviewing progress through the
curriculum will help ICM trainees to compile an effective Personal Development Plan (PDP) of objectives for the
upcoming post. This PDP should be agreed during the Induction Appraisal. The trainee and supervisor should
also both sign the educational agreement in the ICM ePortfolio at this time, recording their commitment to the
training process.

8.2.2. Mid-term appraisal and regular meetings

Regular meetings between trainees and Educational Supervisors are strongly encouraged but a mid-
placement appraisal is expected unless the placement is so short as to make this impractical. These are
particularly important if either the ICM trainee or educational or clinical supervisor has training concerns, or
the trainee has been set specific targeted training objectives at their ARCP. At these meetings, ICM trainees
should review their PDP with their supervisor using evidence from the ICM ePortfolio. Supervised Learning Events
and progress through the curriculum can be reviewed to ensure trainees are progressing satisfactorily, and
attendance at educational events should also be reviewed.

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8.2.3. End of placement appraisal

ICM trainees should review the PDP and curriculum progress with their Educational Supervisor using evidence
from the ICM ePortfolio. Specific concerns may be highlighted at this appraisal. The end of attachment
appraisal should record the areas where further work is required to overcome any shortcomings. Further
evidence of competence in certain areas may be needed, such as planned SLEs, and this should be recorded.
If there are significant concerns following the end of placement appraisal, then the Training Programme
Director should be informed. Information gathered from this meeting should be incorporated into the
Educational Supervisor’s Structured Report (ESSR).

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9. Quality management
Quality Management for the FICM sits within the Training, Assessment and Quality Committee and oversees the
collection of data that allows the FICM to quality manage its training programme. The organisation of training
programmes for Intensive Care Medicine is the responsibility of HEE/local teams and the devolved nations’
Deaneries. The HEE Offices/Deaneries will oversee programmes for postgraduate medical training in their regions.
A Training Programme Director will be responsible for coordinating the ICM training programme in each region.
The Schools and Training Programme Director, accompanied by the Specialty Training Committees in England,
Wales and Northern Ireland and NHS Education Scotland will undertake the following roles:

• engagement with the national recruitment process

• allocate Intensive Care Medicine trainees’ placements and rotations appropriate to their training needs
• oversee the quality of training posts provided locally
• interface with other specialty training faculties (Emergency Medicine, Anaesthesia, etc.) and other healthcare
professionals
• ensure adequate provision of appropriate educational events
• ensure curricula implementation across training programmes
• oversee the workplace-based assessment process within programmes
• coordinate the ARCP process for Intensive Care Medicine trainees
• provide adequate and appropriate career advice
• provide systems to identify and assist doctors with training difficulties
• provide flexible training
• recognise the potential of specific doctors-in-training to progress into an academic career.

Educational programmes to train Educational and Clinical Supervisors and assessors in Supervised Learning
Events may be delivered by HEE Offices/Deaneries or by the FICM or both.

Development, implementation, monitoring and review of the curriculum are the responsibility of the FICM via the
Training, Assessment and Quality Committee. The committee is formally constituted with a lead Dean and the
ICM Trainee Representative. It is the responsibility of the FICM to ensure that curriculum developments are
communicated to Heads of Schools, regional specialty training committees and TPDs.

The FICM serves its role in quality management by monitoring and driving improvement in the standard of all ICM
training. The Training, Assessment, and Quality Committee is actively involved in assisting and supporting
HEE/Deaneries to manage and improve the quality of education within each of their approved training locations.
It is tasked with activities central to assuring the quality of medical education such as writing the curriculum and
assessment systems, reviewing applications for new posts and programmes, provision of external advisors to
Deaneries and recommending ICM trainees eligible for Certificate of Completion of Training (CCT) or Certificate
of Eligibility for Specialist Registration (CESR).

The FICM uses data from seven quality datasets across the specialty to provide meaningful quality management.
The datasets include the GMC National Training Survey (NTS) data, the FICM trainee survey, ARCP outcomes, FICM
exam outcomes, External Advisor reports, Regional Advisor annual reports and annual Recruitment Quality
Assurance reports. These datasets are monitored and reviewed to improve the provision of training and ensure
enhanced educational experiences and form the basis of the annual report to the GMC on the quality of ICM
training nationally. These principles will be transferred to the new curriculum to ensure this continues.

An annual publication, the Quality Management of Training Report, is available publicly on the FICM website.

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10. Intended use of the curriculum by ICM trainers and trainees

The curriculum is a crucial document for ensuring the quality and consistency of training and assessment. It
must be referred to throughout training as ICM trainees record evidence demonstrating their developing skills
and knowledge, progressing towards achievement of the HiLLOs.

The curriculum should be used to help design training programmes locally that ensure all ICM trainees can
develop the necessary skills and knowledge in a variety of settings and situations. The curriculum is designed
to ensure it can be applied in a flexible manner, meeting service needs as well as supporting each trainee’s
own tailored learning and development plan. This curriculum, and further guidance documents will be
available in due course via the FICM website.

Clinical and educational supervisors should use the curriculum and guidance documents as the basis of their
discussion with ICM trainees. The ICM trainees are themselves expected to have a good knowledge of the
curriculum and should use it as a guide for their training programme. Each ICM trainee will engage with the
curriculum by maintaining a record of their progress on the ICM ePortfolio. The trainee will use the curriculum
to develop learning objectives and reflect on learning experiences. ICM trainees will have different strengths
and areas of interest, and so may be able to demonstrate achievement of some learning outcomes at
different rates.

Recording progress on the ICM ePortfolio

On enrolling with the FICM, trainees will be given access to the ICM ePortfolio. This platform allows evidence to
be built up to inform decisions on a trainee’s progress and provides tools to support their education and
development.

The ICM trainee’s main responsibilities are to ensure their ePortfolio record is kept up to date, arrange
assessments and ensure they are recorded, prepare drafts of appraisal forms, maintain their PDP, record their
reflections on learning and record their progress through the curriculum.

The supervisor’s main responsibilities are to use the ePortfolio evidence such as outcomes of assessments,
reflections and PDPs to inform appraisal meetings. They are also expected to update the ICM trainee’s record
of progress through the curriculum, produce end of placement appraisals and supervisor’s reports.

HEE/Deaneries, TPDs, Faculty Tutors and ARCP panels will use the ICM ePortfolio to monitor the progress of ICM
trainees for whom they are responsible. The FICM will use summarised, anonymised data from the ePortfolio to
support its work in quality assurance.

All appraisal meetings, personal development plans, supervised learning events and MSFs, should be recorded
in the ICM ePortfolio. ICM trainees are encouraged to reflect on their learning experiences and to record these
in the ePortfolio. Reflections can be kept private or shared with supervisors.

Reflections, assessments and other ICM ePortfolio content should be used to provide evidence towards
acquisition of curriculum requirements.

10.1. Ongoing management of the curriculum by the Faculty

The FICM’s Training, Assessment and Quality Committee will regularly review the curriculum to ensure it
remains fit for purpose, reflecting current training and service needs.

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

Our contact email address ([email protected]) for all enquiries will be the conduit through which
stakeholders will be able to submit feedback on any element of the curriculum.

The Training, Assessment and Quality Committee will review the feedback and either approve or reject the
proposed revisions on an annual basis. Should any revisions be proposed to the High-Level Learning
Outcomes (HiLLOs) or the Key Capabilities, amendments will only be made where a clear rationale exists for
doing so, such as where it is necessary to address patient safety concerns or reflect a significant change in
contemporary practice in Intensive Care Medicine, and every effort will be made to minimise any negative
impact on ICM trainees.

Following submission to and approval from the GMC as the regulatory body, updated curriculum annexes will
be issued prior to the start of the training year, making clear (using the version tracking table at the front of the
document) what amendments have been made on each occasion.

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

11. Equality and diversity

The FICM will comply, and ensure compliance, with the requirements of equality and diversity legislation set out
in the Equality Act 2010.

The FICM believes that equality of opportunity is fundamental to the many and varied ways in which
individuals become involved with the Faculties and Colleges, either as members of staff and Officers; as
advisers from the medical profession; as members of the Faculties/Colleges' professional bodies or as doctors
in training and examination candidates.

HEE/Deaneries will quality assure each training programme so that it complies with the equality and diversity
standards in postgraduate medical training as set by GMC. They should provide access to a professional
support unit or equivalent for ICM trainees requiring additional support.

Compliance with anti-discriminatory practice will be assured through:

• monitoring of recruitment processes

• ensuring all Faculty representatives and Programme Directors have attended appropriate training
sessions prior to appointment or within 12 months of taking up post
• HEE/Deaneries ensuring that educational supervisors have had equality and diversity training (for
example, an e-learning module) every 3 years
• HEE/Deaneries ensuring that any specialist participating in ICM trainee interview or appointments
committees, or processes has had equality and diversity training (at least as an e-module) in the
preceding 3 years
• ensuring ICM trainees have an appropriate, confidential, and supportive route to report examples of
inappropriate behaviour of a discriminatory nature. HEE/Deaneries and Programme Directors must ensure
that on appointment, ICM trainees are made aware of the route in which inappropriate or discriminatory
behaviour can be reported and supplied with relevant contact details. HEE/Deaneries must also ensure
contingency mechanisms are in place if ICM trainees not satisfied with the response or feel unable to use
the process as described, such as being unable to approach the nominated contact individual as a
result of conflicted interest
• providing resources to ICM trainees needing support (for example, through the provision of a professional
support unit or equivalent)
• monitoring of FICM Examinations
• ensuring all assessments discriminate on objective and appropriate criteria and do not unfairly
advantage or disadvantage an ICM trainee with any of the Equality Act 2010 protected characteristics. All
efforts shall be made to ensure the participation of people with a disability in training through reasonable
adjustments; recognising that not all disabilities are visible.

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

12. Annexes
Annex A – ICM High-Level Learning Outcomes

1. The doctor will be able to function successfully within NHS organisational and management systems whilst
adhering to the appropriate legal and ethical framework.

They:
KEY CAPABILITIES
• Understand, incorporate and implement national legislation (eg Health and Social Care
Act 2012 and the Equality Act 2010 (Disability Discrimination Act 1995 in Northern Ireland))
into everyday practice.
• Successfully and ethically incorporate information technology and governance,
according to national legislation, into patient care
• Can communicate & document effectively, according to ethical and legal frameworks to
promote the highest standards of healthcare
• Know how to interpret, construct and apply ethical and legal frameworks into all areas of
clinical governance
• Demonstrate the highest professional behaviours, individually and corporately
• Continually strive to enhance and integrate knowledge into clinical practice and the NHS
organisation as a whole, whilst observing legal and ethical obligations.

Domain 1: Professional values and behaviours

GPC Domains
Domain 2: Professional skills
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 3: Professional knowledge
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries
Domain 6: Capabilities in patient safety and quality improvement
Domain 7: Capabilities in safeguarding vulnerable groups

 ACAT
Evidence to inform
 CBD
decision
 MSF
 Involvement in developing clinical or organisational policies and procedures
 Attendance at management meetings
 Postgraduate qualifications or evidence of further study in management/leadership
 Portfolio evidence of self-study eg eLfH
 ES Report

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

2. The doctor will be focused on patient safety and will deliver effective quality improvement, whilst practising
within established legal and ethical frameworks.

They will:
KEY CAPABILITIES
• Adhere to national legislation and guidelines relating to safeguarding children and other
vulnerable groups of patients, such as those with protected characteristics
• Contribute towards quality improvement, communicate effectively and share good
practice
• Optimise care of critically unwell patients by the critical appraisal of recent medical
literature and the application of evidence-based guidelines
• Demonstrate a commitment to learn from critical incidents and adverse events as well as
sharing the learning points from these experiences
• Communicate effectively with patients, their families and professional colleagues whilst
recognising and effectively managing any barriers to effective communication
• Ensure patient safety is the key priority at all times in their clinical practice both within the
intensive care unit and in the wider clinical environment of the hospital.

Domain 1: Professional values and behaviours

GPC Domains
Domain 2: Professional skills
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 4: Capabilities in health promotion and illness prevention
Domain 6: Capabilities in patient safety and quality improvement
Domain 7: Capabilities in safeguarding vulnerable groups
Domain 9: Capabilities in research and scholarship

 ACAT
Evidence to inform
 CBD
decision
 Mini-CEX
 DOPS
 MSF
 Involvement in quality improvement
 Portfolio evidence of self-study
 ES Report

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

3. An Intensive Care Medicine specialist will know how to undertake medical research including the ethical
considerations, methodology and how to manage and interpret data appropriately.

To ensure this is the case they will:

KEY CAPABILITIES
• Remain up to date in their reading of current research literature and best practice
guidelines
• Have an understanding of the processes and governance of clinical research, and will be
able to communicate this to patients and their relatives where appropriate
• Be able to critically appraise clinical literature, and to apply this, when appropriate, to their
clinical practice
• Use their knowledge of the ethical principles of practising medicine, and the legal
framework associated with this in modern healthcare to benefit their patients
• Have the ability to organise the collection and interpretation of data collected from their
own intensive care unit and use this as a method of improving clinical services locally
• Apply information derived from population data to help inform individual treatment plans
for their patients.

Domain 1: Professional values and behaviours

GPC Domains
Domain 9: Capabilities in research and scholarship

 ACAT
Evidence to inform
 CBD
decision
 Qualifications or evidence of further study involving undertaking research eg Good
Clinical Practice
 Involvement in research studies within the department or further study eg MSc/MD/PhD
 Involvement in journal clubs or similar
 Portfolio evidence of self-study
 ES Report

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

4. To ensure development of the future medical workforce, a doctor working as a specialist in Intensive Care
Medicine will be an effective clinical teacher and will be able to provide educational and clinical supervision.

They will:
KEY CAPABILITIES
• Deliver effective teaching and training to medical students, doctors in training, colleagues
and members of the wider multidisciplinary team. This will include understanding the
teaching, assessment and feedback needs of learners from all groups with protected
characteristics and being able to adapt teaching and provide supportive techniques to
ensure successful and equitable learning outcomes.
• Competently assess the performance of learners objectively and deliver timely and
constructive feedback on learning activities in accordance with current educational
standards and best practice
• Meet any regulatory requirements of a trainer and will keep these current as well as
participating in quality assurance processes to ensure excellent undergraduate and
postgraduate training
• Endeavour to ensure patient involvement and feedback is integral to the delivery of
education to doctors in their individual roles as well as their role as a member of the
multidisciplinary team.

Domain 1: Professional values and behaviours

GPC Domains
Domain 8: Capabilities in education and training

 ACAT
Evidence to inform
 MSF
decision
 Portfolio evidence of feedback and learning from teaching delivered
 Postgraduate qualifications or evidence of further study in medical education (eg PGCert)
 ES Report

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

5. Doctors specialising in Intensive Care Medicine can identify, resuscitate and stabilise a critically ill patient, as
well as undertake their safe intra-hospital or inter-hospital transfer to an appropriately staffed and equipped
facility.

They will:
KEY CAPABILITIES
• Identify an acutely ill patient or one at risk of significant deterioration by taking account of their medical
history, clinical examination, vital signs and available investigations
• Integrate clinical findings with timely and appropriate investigations to form a differential diagnosis and
an initial treatment plan
• Administer intravenous fluids and inotropic drugs as clinically indicated utilising central venous access
where required and monitoring the effectiveness of these treatments with invasive monitoring techniques
• Stabilise and initiate an initial treatment plan for a critically ill acute surgical, acute medical or peripartum
patient including those with sepsis or post-trauma and institute timely antimicrobial therapy
• Provide definitive airway management and initiate and maintain advanced respiratory support
• Undertake the transport of mechanically ventilated critically ill patients outside the Intensive Care Unit
when required
• Communicate effectively and in a timely manner, with fellow members of the multi-disciplinary team
including those from other specialties and make an accurate, legible and contemporaneous entry in the
patient’s medical record
• Where escalation of care is required, be able to arrange this and provide a succinct structured handover
to clinical colleagues
• Recognise when a patient has the potential to deteriorate or requires future treatment escalation and be
able to provide explicit instructions regarding an ongoing treatment plan and contact details should a
further review be required
• Have the ability to communicate with a patient's family, in terms they can understand, the patient's clinical
condition, current and likely future treatment options and where possible, an indicative prognosis in an
empathetic and understanding manner
• Be mindful at all times that whilst assessing and treating patients they must maintain optimum safety for
their patients by recognising any limitations of their current clinical environment, the available equipment
and personnel and employing best practice guidelines where these exist.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection control and
communicable disease)
Domain 5: Capabilities in leadership and teamworking
Domain 6: Capabilities in patient safety and quality improvement
 ACAT
Evidence to
 CBD
inform decision
 Mini-CEX
 DOPS
 Portfolio evidence of logbook of procedures
 Attendance at transfer courses
 FFICM examinations
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

6. Intensive Care Medicine specialists will have the knowledge and skills to initiate, request and interpret
appropriate investigations and advanced monitoring techniques, to aid the diagnosis and management of
patients with organ systems failure. They will be able to provide and manage the subsequent advanced organ
system support therapies. This will include both pharmacological and mechanical interventions.

This means they can:

KEY CAPABILITIES
• Initiate, perform, interpret and integrate point-of-care testing, radiological and laboratory
investigations with their patient’s clinical findings
• Integrate knowledge, skills and investigations to treat a patient who is deteriorating and institute or
escalate organ support therapies
• Perform invasive procedures to aid the diagnosis and management of a critically ill patient, and
provide advanced organ-support therapies as well as monitor the effectiveness of these therapies
in improving the patient's overall condition
• Use their knowledge, apply their skills, and interpret investigations and advanced therapeutic
monitoring data to manage critically ill patients, including safe prescribing practices and advanced
organ system support modalities, throughout the course of their critical illness.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection control and
communicable disease)
Domain 3: Professional knowledge
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries

 ACAT
Evidence to
 CBD
inform decision
 Mini-CEX
 DOPS
 Formal intensive care ultrasound accreditation with demonstration of appropriate maintenance of
skill
 Portfolio evidence of self-study eg eLfH
 FFICM examinations
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

7. Specialists in Intensive Care Medicine can provide pre-operative resuscitation and optimisation of patients,
deliver post-operative clinical care including optimising their physiological status, provide advanced organ
system support and manage their pain relief.

To achieve this, they will therefore:

KEY CAPABILITIES
• Have the knowledge and understanding of the care of patients undergoing a wide range
of operative procedures
• Be expert in resuscitating and stabilising patients before and after a wide range of
operative procedures including sold organ transplantation
• Have an awareness of and be able to treat the common complications of a broad range
of operative procedures including solid organ transplantation
• Lead and contribute to the skill mix of a multidisciplinary team that will deliver the
perioperative management of patients undergoing surgical procedures.

Domain 1: Professional values and behaviours

GPC Domains
Domain 2: Professional skills
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 5: Capabilities in leadership and teamworking

 ACAT
Evidence to inform decision
 CBD
 Mini-CEX
 DOPS
 Portfolio evidence of self-study eg e-LfH
 FFICM examinations
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

8. Doctors specialising in Intensive Care Medicine will understand and manage the physical and psychosocial
consequences of critical illness for patients and their families, including providing pain relief, treating delirium
and arranging ongoing care and rehabilitation. They will also manage the withholding or withdrawal of life-
sustaining treatment, discussing end of life care with patients and their families and facilitating organ donation
where appropriate.

In order to do this, they will be expert in:

KEY CAPABILITIES
• Identifying and limiting the physical and psychosocial consequences of critical illness for
patients and families paying particular attention to the assessment, prevention and
treatment of pain and delirium
• Communicating the continuing care requirements of patients at discharge from both ICU
and hospital to healthcare professionals, patients and relatives. This will include the
patient’s plan for ongoing care, medical follow up and rehabilitation
• Facilitating discussions focused on how to manage end of life care with patients and their
families. The process of withholding or withdrawing life-sustaining treatments and
providing palliative care whilst maintaining respect for cultural and religious beliefs will
form an important element of this
• Diagnosing death using neurological criteria and diagnosing death using circulatory
criteria in time sensitive scenarios (eg donation after circulatory death).
• Identifying likely organ donors, working collaboratively with specialist nurses for organ
donation and facilitating the process of organ donation, including providing appropriate
physiological support to the organ donor.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 3: Professional knowledge
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries
Domain 5: Capabilities in leadership and teamworking

 ACAT
Evidence to inform decision
 CBD
 DOPS
 Mini-CEX
 Portfolio evidence of self-study eg e-LfH
 FFICM examinations
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

9. Intensive Care Medicine specialists will have the skillset and competence to lead and manage a critical care
service, including the multidisciplinary clinical team and providing contemporaneous care to a number of
critically ill patients.

They will do this by:

KEY CAPABILITIES
• Providing support to colleagues and contributing to the management of acutely unwell
patients outside of the critical care unit when requested to do so
• Having the leadership and communication skills to head a culturally diverse
multidisciplinary team providing care to an equally diverse range of patients on the
critical care unit
• Involving patients and their relatives in as many treatment decisions as circumstances will
allow whilst ensuring patients and relatives are kept abreast of the current treatment plan
and options
• Actively participating in the development and application of systems and processes
designed to improve the delivery of safe care for critically ill patients.
• Understanding and being able to describe the special requirements of a mass casualty
incident.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 3: Professional knowledge
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries
Domain 5: Capabilities in leadership and teamworking
Domain 7: Capabilities in safeguarding vulnerable groups

 ACAT
Evidence to inform decision
 CBD
 MSF
 FFICM examinations
 Postgraduate qualifications or evidence of further study involving
leadership/management
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

10. Intensive Care Medicine specialists will have developed the necessary skills of induction of anaesthesia, airway
control, care of the unconscious patient and understanding of surgery and its physiological impact on the
patient.

They will be able to:

KEY CAPABILITIES
• Conduct comprehensive pre-anaesthetic and pre-operative checks
• Demonstrate knowledge of anatomy, physiology, biochemistry and pharmacology
relevant to anaesthetic practice
• Describe the functioning principles of standard equipment used within anaesthetic
practice and understand the physical principles governing the operation of such
equipment and the clinical measurements derived from them
• Pre-operatively assess ASA 1-3 patients’ suitability for anaesthesia, prescribe suitable pre-
medication and recognise when further investigation or optimisation is required prior to
commencing surgery and adequately communicate this to the patient and their family
• Safely induce anaesthesia in ASA 1-3 patients and recognise and deal with complications
associated with the induction of anaesthesia
• As a member of the multi-disciplinary theatre team, maintain anaesthesia for the relevant
procedure, utilise appropriate monitoring and effectively interpret the information it
provides to ensure the safety of the anaesthetised patient
• Recognise anaesthetic critical incidents, understand their causes and how to manage
them
• Safely care for a patient recovering from anaesthesia and recognise and treat the
common associated complications whilst providing appropriate post-operative
analgesia (including that via regional and neuraxial blockade), anti-emesis and fluid
therapies
• Provide urgent or emergency anaesthesia to ASA 1E and 2E patients requiring non-
complex emergency surgery
• Identify patients with difficult airways, demonstrate management of the ‘cannot intubate
cannot oxygenate’ scenario in simulation, and be familiar with difficult airway guidelines.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 5: Capabilities in leadership and teamworking

 CBD
Evidence to inform decision
 Mini-CEX
 DOPS
 FFICM examinations
 ES Report
 Simulation
 MSF

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

11. In order to manage acutely ill patients outside the Intensive Care Unit, an Intensive Care Medicine specialist will
have the diagnostic, investigational and patient management skills required to care for ward-based patients
whose condition commonly requires admission to the intensive care unit.

They will:
KEY CAPABILITIES
• Be able to manage an acute unselected take
• Manage an acute specialty-related take
• Be capable of providing continuity of care to medical in-patients, including management
of comorbidities and cognitive impairment
• Know how to manage patients in an outpatient clinic, ambulatory or community setting
(including management of long-term conditions)
• Have the ability to assess and treat medical problems in patients in other specialties and
special cases
• Make an active contribution to the functioning of a multi-disciplinary clinical team
including effective discharge planning
• Deliver effective resuscitation and manage an acutely deteriorating patient
• Care for patients who require end of life care as well as those who require palliative care.

Domain 1: Professional values and behaviours

GPC Domains
Domain 2: Professional skills
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 5: Capabilities in leadership and teamworking

 ACAT
Evidence to inform decision
 CBD
 Mini-CEX
 DOPS
 Portfolio evidence of self-study eg e-LfH
 FFICM examinations
 ES Report
 MSF
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

12. Doctors specialising in Intensive Care Medicine understand the special needs of, and are competent to manage
patients with neurological diseases, both medical and those requiring surgery, which will include the
management of raised intracranial pressure, central nervous system infections and neuromuscular disorders.

They will care for these patients by:

KEY CAPABILITIES
• Understanding and assessing the perioperative risks associated with patient
comorbidities, emergency anaesthesia and surgery and the implications of concomitant
drug therapies in these patients
• Being competent in the postoperative care of common acute and chronic medical
conditions commonly found in these patients
• Being aware of the effects of major neurological surgery on these patients and the
associated immediate postoperative management of these patients including the
common complications and providing optimal analgesia
• Knowing the factors which influence the intensity, levels of care and the clinical
environments where the necessary care can be safely delivered to patients with
neurological disease
• Recognising and treating respiratory and cardiovascular dysfunction with their associated
complications commonly encountered in these patients
• Effectively assessing and managing other perioperative conditions and complications
encountered by pre- and post-operative neurosurgical and neurological patients
• Being able to competently assess a patient’s neurological status and provide appropriate
support where necessary
• Having a thorough understanding of the pathophysiology of raised intracranial pressure
including the options for its operative and non-operative management
• Providing immediate treatment of perioperative emergencies in neurosurgical and
neurological patients and knowing when to seek senior help and support.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 5: Capabilities in leadership and teamworking

 ACAT
Evidence to inform
 CBD
decision
 Mini-CEX
 DOPS
 Portfolio evidence of self-study eg eLfH
 FFICM examinations
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

13. A specialist in adult Intensive Care Medicine is competent to recognise, provide initial stabilisation and manage
common paediatric emergencies until expert advice or specialist assistance is available. They are familiar with
legislation regarding safeguarding children in the context of Intensive Care Medicine practice.

They:
KEY CAPABILITIES
• Know and can effectively manage the major anatomical, physiological and psychological
differences between adult and paediatric patients
• Appreciate the pathophysiology of common paediatric emergencies, recognise their
presentation and can provide initial management until expert help or specialist
assistance is available
• Are able to provide emergency and continuing cardiovascular support to a child until
expert help or specialist assistance is available
• Are capable of resuscitating a child, know when to seek specialist help and support via
their local paediatric retrieval team whose processes they are familiar with
• Are competent to provide elective and emergency airway management and mechanical
ventilation to a child including induction of anaesthesia for intubation
• Practise in accordance with national legislation and guidelines relating to safeguarding
children in the context of critical care.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 5: Capabilities in leadership and teamworking
Domain 7: Capabilities in safeguarding vulnerable groups

 ACAT
Evidence to inform decision
 CBD
 Mini-CEX
 DOPS
 Portfolio evidence of self-study eg eLfH
 Attendance at relevant courses eg APLS
 Attendance at relevant child safeguarding courses
 FFICM examinations
 ES Report
 Simulation

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 ICM Curriculum:
Supporting Excellence for a CCT in Intensive Care Medicine

14. Intensive Care Medicine specialists recognise the special needs of, and are competent to provide the
perioperative care to patients who have undergone cardiothoracic surgery, including providing pain relief and
advanced organ system support utilising specialised techniques available to support the cardiovascular
system.

They are competent in:

KEY CAPABILITIES
• Assessing the perioperative risks associated with these patients’ co-morbidities,
emergency anaesthesia and surgery and the implications of their concomitant drug
therapies
• The postoperative care of common acute and chronic medical conditions commonly
found in these patients
• Assessing the implications of the type and site of surgery for these patients’ immediate
postoperative management and the potential complications, which they can manage
effectively whilst providing optimal analgesia
• Considering the factors which influence the intensity, levels of care and the clinical
environments where the necessary care can be safely delivered to these patients
• Treating respiratory dysfunction and complications in these patients
• Treat cardiovascular dysfunction and complications in these patients including
understanding advanced monitoring techniques and provision of mechanical circulatory
support
• Assessing and managing other perioperative conditions and complications encountered
by pre- and post-operative cardiothoracic surgery patients
• Recognising and providing immediate treatment of perioperative emergencies and know
when to seek senior help and support.

Domain 2: Professional skills

GPC Domains
• practical skills
• communication and interpersonal skills
• dealing with complexity and uncertainty
• clinical skills (history taking, diagnosis and medical management; consent; humane
interventions; prescribing medicines safely; using medical devices safely; infection
control and communicable disease)
Domain 5: Capabilities in leadership and teamworking

 ACAT
Evidence to inform decision
 CBD
 Mini-CEX
 DOPS
 Portfolio evidence of self-study eg eLfH
 FFICM examinations
 ES Report
 Simulation

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Annex B – Special Skills Modules: Learning Objectives

Academic Research - Special Skills Module

SSY Target
Learning Objectives
capability level

Appreciate the difference between audit and research, have a clear oversight of the ethical principles
4
involved in conducting research and have a good understanding of the difference types of study design

Complete Good Clinical Practice (GCP) for clinical trials and have an oversight of the complex regulatory
4
framework behind research including the Integrated Research Application System (IRAS)

Formulate a focused research question, undertake a systematic comprehensive literature search and be
4
able to critically appraise the literature in addition to having a solid grounding in medical statistics

Have a comprehensive grasp of the management of clinical trials including the role of the National Institute
Health Research (NIHR) as both a funder and the body that delivers high quality research and actively 4
engage in recruitment to NIHR research studies

Engage directly in a research project related to ICM and present the results at a national meeting resulting
4
ultimately in a peer-reviewed publication

Domain 3: Professional knowledge

GPC Domains
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries
Domain 5: Capabilities in leadership and teamworking
Domain 6: Capabilities in patient safety and quality improvement
Domain 9: Capabilities in research and scholarship
 Portfolio evidence of self-study eg e-LfH
Evidence to
 Academic Supervisors Report
inform decision
 Appropriate statistics course attendance
 Evidence of academic activity eg courses, presentations, funding applications, awards, abstracts

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Cardiothoracic Intensive Care Medicine - Special Skills Module

SSY Target capability

Learning Objectives
level
Understands the causes and can manage a peri-arrest cardiac surgery patient in the perioperative
period as well as being able to manage cardiopulmonary resuscitation and post-resuscitation care in 4
these patients

Can initiate and interpret the results of advanced cardiovascular monitoring techniques 3

Is able to provide multi-organ system support and in the context of underlying cardiopulmonary disease 4

Is able to manage the clinical care of non-surgical patients commonly seen in a cardiothoracic intensive
care unit including pregnancy associated pathologies, heart and lung transplantation, structural and 3
vascular heart disease and congenital heart disease

Manages the care of patients with cardiac disease who have critical illness due to non-cardiac causes 3

Manages the care of the patient following cardiothoracic trauma 3

Understands the principles behind and the functioning of mechanical support devices for the
3
cardiovascular system

Is able to treat cardiac dysrhythmias by the use of external and internal pacing devices 4

Is able to provide perioperative care for patients who have undergone cardiac surgical procedures care
and can provide perioperative care for patients with cardiothoracic disease undergoing non-cardiac 4
surgical procedures

Manages the palliative care of the patient with end stage heart or lung disease 4

Describes the care of the patient prior to and following thoracic solid organ transplantation (heart, lung,
3
heart-lung)

Describes the management of common congenital heart conditions in the adult patient 3

Understands ICU risk scoring systems in the context of cardiothoracic ICU practice 4

Is able to contribute to functioning of the multi-disciplinary team to provide optimal clinical and to
4
participate in perioperative planning and clinical governance meetings

Domain 2: Professional skills

GPC Domains
Domain 5: Capabilities in leadership and team working
Domain 6: Capabilities in patient safety and quality improvement
 ACAT
Evidence to
 CBD
inform decision
 DOPS
 Mini-CEX
 MSF
 Simulation
 Attendance Records

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 ICM Curriculum:
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Echocardiography - Special Skills Module

SSY Target capability

Learning Objectives
level

Will understand the technology, uses and care of echocardiography equipment, applying the skills and
knowledge to perform and interpret studies and views in critically unwell patients. They will also be 3
capable of supervising others to do so.

Will be able to accurately and clearly record echocardiography findings, and safely store images and
3
studies for recall.

Will apply high personal standards of clinical governance, and understand the governance structure of
an echocardiography service, while engaging and collaborating with the local echocardiography 4
community.

Domain 2: Professional skills

GPC Domains
Domain 5: Capabilities in leadership and team working
Domain 6: Capabilities in patient safety and quality improvement
Domain 9: Capabilities in research and scholarship
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Mini-CEX
 MSF
 Examination (Level 1 BSE) optional
 Logbook
 Peer review

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 ICM Curriculum:
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Extracorporeal Membrane Oxygenation (ECMO) - Special Skills Module

SSY Target capability

Learning Objectives
level

Can assess a patient's suitability for ECMO therapy 3

Initiates ECMO therapy including cannulation, and management of complications 3

Leads the daily multidisciplinary ward round of patients on ECMO 3

Transfers patients between hospitals on ECMO 2

Transfers patients within the hospital on ECMO 3

Understands the multi-disciplinary team required to provide ECMO within the NHS 4

Takes part in clinical governance activities relating to ECMO 4

Domain 1: Professional values and behaviours

GPC Domains
Domain 5: Capabilities in leadership and team working
Domain 6: Capabilities in patient safety and quality improvement
Domain 8: Capabilities in education and training
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Mini-CEX
 Simulation
 MSF

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 ICM Curriculum:
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Home Ventilation - Special Skills Module

SSY Target capability

Learning Objectives
level

Understands the pathophysiology of CRF and will recognise the various ways that patients present to
4
domiciliary ventilation services

Is able to make an initial assessment of patients with CRF including arranging and interpreting
4
appropriate investigations

Understands the different organisational models of home ventilation within the NHS 4

Is able to manage the end of life care of patients with CRF 3

Understands the role of multi-disciplinary teams in the long-term management of patients with CRF 4

Is able to assess and develop a weaning strategy for difficult to wean patients including their
3
rehabilitation needs

Is able to use a range of ventilators and adjunct devices in the treatment of CRF including tracheostomy 4

Domain 2: Professional skills

GPC Domains
Domain 4: Capabilities in health promotion and illness prevention
Domain 7: Capabilities in safeguarding vulnerable groups
Domain 9: Capabilities in research and scholarship
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Mini-CEX
 MSF

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 ICM Curriculum:
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Neuro Intensive Care Medicine - Special Skills Module

SSY Target capability

Learning Objectives
level

Can recognise, resuscitate and initiate treatment of the patient with acute neurological injury, having an
enhanced understanding of the specific neuropathophysiologies. They will be able to institute advanced
4
pharmacological and physical therapeutic interventions, and continue ongoing diagnostic and disease
management strategies, including multi-organ support.

Can initiate and interpret the results of advanced neuro imaging techniques and monitoring
3
technologies, understanding their fundamental principles, indications and safety profiles.

Will be capable of diagnostic and treatment strategies for the specific presentations and provide
3
ongoing management and care.

Is able to provide comprehensive perioperative care for patients who are to undergo neurosurgical
4
procedures.

Will provide high quality comfort, care and dignity to optimise a neurocritical care patient's recovery and
4
outcome.

Understands the principles, practicalities and consequences of neurological injury and rehabilitation 3

Domain 1: Professional values and behaviours

GPC Domains
Domain 2: Professional skills
Domain 5: Capabilities in leadership and team working
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Mini-CEX
 MSF
 Simulation

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 ICM Curriculum:
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Paediatric Intensive Care Medicine - Special Skills Module

SSY Target
Learning Objectives
capability level

Recognise, assess and manage the full range of both medical and surgical paediatric conditions requiring
3
intensive care support, including the management of safeguarding issues within this environment.

Assume the role of Paediatric Intensive Care Team Lead for a non-specialist hospital and liaise with hospital
and community specialist teams, effectively manage and coordinate patient flow, staffing, safety and 3
quality in the context of emergency paediatric care in a non-specialist hospital

Effectively lead the team in resuscitating, stabilising and transferring a critically ill child, perform the and
supervise others in performing high-level clinical and technical skills and procedures necessary to carry this
3
out in paediatric patients in a non-specialist hospital’s intensive care, emergency and transport
environments.

Perform and supervise others performing high-level technical skills and procedures utilising the appropriate
3
medications necessary for managing critically ill children in a non-specialist hospital

Supports and communicates with families when their child is extremely unwell, dying or has died. 4

Domain 3: Professional knowledge

GPC Domains
• professional requirements
• national legislative requirements
• the health service and healthcare systems in the four countries
Domain 5: Capabilities in leadership and teamworking
Domain 6: Capabilities in patient safety and quality improvement
Domain 7: Capabilities in safeguarding vulnerable groups
Domain 9: Capabilities in research and scholarship
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Simulation
 MSF
 ES Report
 Portfolio evidence of self-study e.g. e-LfH

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 ICM Curriculum:
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Quality Improvement - Special Skills Module

SSY Target
Learning Objectives
capability level

Understands the principles and purpose of quality improvement including evidence-based practice, best
practice guidelines and benchmarking, as well as being able to appreciate different sampling 4
methodology.

Can propose, initiate, implement, develop and evaluate protocols, guidelines and quality improvement 4

Can collate, manage and interpret information gathered from different resources 4

Can understand and apply statistical modelling, including variance and graphical models, to analyse,
4
organise and present information

Can describe the general change, reliability and lean concepts 4

Understands the principles and structure of local and national healthcare provision and management,
4
including health economics, departmental budgeting, development and preparation of business plans.

Understands the role of the ICU specialist outwith the intensive care unit in raising the profile of the
4
Specialty within the hospital and to the general population

Recognises and promotes change within ICU to improve healthcare provision and adopts strategies to
4
minimise and counter resistance to such change.

Work effectively within the MDT by respecting, acknowledging and collaborating with others to achieve a
4
common goal

Understands the principles of group dynamics 4

Demonstrates proficiency in leadership and communication through providing supervision to members of

MDT, conducts and chairs meetings and by managing conflict between different professional and patient 4
groups

Delivers effective teaching and training to medical and non-medical members of the healthcare team 4

Domain 4: Capabilities in health promotion and illness prevention

GPC Domains
Domain 6: Capabilities in patient safety and quality improvement
Domain 8: Capabilities in education and training
Domain 9: Capabilities in research and scholarship
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Mini-CEX
 MSF
 Simulation

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Transfer Intensive Care Medicine - Special Skills Module

SSY Target
Learning Objectives
capability level

Contrast the risks and benefits associated with emergent inter-facility transfer 4

Describe the physiological and physical effects of movement of patients 4

Describe the principles of planning and co-ordinating patient transfer 4

Demonstrate a professional approach to the planning and co-ordination of patient transfer 4

Demonstrate correct preparation of patients for safe inter-facility transfer 4

Demonstrate a professional approach to preparation of patients for transfer 4

Differentiate the risks and benefits of road, helicopter, fixed wing and other transport modalities 4

Demonstrate the ability to transfer patients using a range of modalities 4

Describe the common problems experienced during patient transfer 4

Demonstrate the safe inter-facility transfer of all age groups of ventilated patients 4

Demonstrate a professional approach to the clinical management of patients undergoing emergent

4
inter-facility transfer

Domain 1: Professional values and behaviours

GPC Domains
Domain 2: Professional skills
Domain 6: Capabilities in patient safety and quality improvement
Domain 8: Capabilities in education and training
 ACAT
Evidence to inform
 CBD
decision
 DOPS
 Mini-CEX
 Simulation

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 ICM Curriculum:
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Education - Special Skills Module

SSY Target
Learning Objectives
capability level

Can deliver educational sessions pertinent to learners from varying backgrounds and levels of prior
knowledge using a variety of teaching formats (e.g. small group, lecture, e-learning) demonstrating
4
appropriate planning and design, considering awareness of the curriculum and learner needs, use of
teaching methods and technology and showing evaluation and plans for improvement of future sessions

Can deliver simulation teaching with assistance from faculty, considering the evidence base and teaching
theory related to simulation teaching, awareness of levels of fidelity and relevant
3
advantages/disadvantages of this teaching format. Aware of use in relation to critical incidents and non-
technical and communication skills teaching

Uses assessment tools in the workplace appropriately, demonstrating theoretical knowledge including
awareness of validity, reliability and feasibility of the assessment tools chosen and how this influences the 4
choice of assessments used to maximise learning

Provides structured feedback appropriately after learning encounters demonstrating awareness of various
models of feedback. Demonstrates professionalism and empathy during this process and shares 4
enthusiasm for teaching and learning in the clinical environment

Produces an educational portfolio demonstrating involvement in educational activities aligned with GMC
guidance on recognition and approval of trainers, including involvement in teaching and learning,
3
appropriate use of assessment, supporting and monitoring learners, guiding personal and professional
development and developing own skills as an educator

Can organise an educational event, considering choice of topic, speakers and environment and manages
3
a system for collecting feedback and using this to improve future events

Demonstrate skills in leadership and management relating to education and what role clinicians
specialising in medical education may have at a local or regional level to influence change and improve 3
teaching and learning in the workplace

Can critically evaluate research within medical education, showing up-to-date knowledge of
developments within this field and applies new knowledge learnt to improve their own practice. Shows 4
willingness to share knowledge with others.

Domain 1: Professional values and behaviours

GPC Domains
Domain 4: Capabilities in health promotion and illness prevention
Domain 8: Capabilities in education and training
 Peer observed teaching session feedback
Evidence to inform
 ES Report
decision
 Presentation session feedback
 MSF
 Portfolio evidence of self-study e.g. e-LfH, continuing professional development record
 Assessment design and delivery tool - feedback from ES
 Formal qualification in medical education
 Evidence of lead organiser for a non-departmental educational meeting

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Annex C – Abbreviations

Abbreviation Term
ACAT Acute Care Assessment Tool for Intensive Care Medicine
ACCP Advanced Critical Care Practitioner
ACCS Acute Care Common Stem
AIM Acute Internal Medicine
APLS Advanced Paediatric Life Support
ARCP Annual Review of Competency Progression
CAT Core Anaesthetic Training
CCT Certificate of Completion of Training
CBD Case-based Discussion
CESR Certificate of Eligibility for Specialist Registration
CoBaTrICE Competency Based Training programme in Intensive Care Medicine for Europe
CS Clinical Supervisor
CT Core Training
DOPS Direct Observation of Procedural Skills
e-LfH e-Learning for Health
e-ICM e-Learning module for ICM on the e-LfH platform
EM Emergency Medicine
ES Educational Supervisor
ESSR Educational Supervisor’s Structured Report
ESICM European Society of Intensive Care Medicine
FFICM Fellowship of the Faculty of Intensive Care Medicine
FICM Faculty of Intensive Care Medicine
FT ICM Faculty Tutor
GMC General Medical Council
GPCs Generic Professional Capabilities
HDU High Dependency Unit
HEE Health Education England
HEIW Health Education and Improvement Wales
HiLLO High-Level Learning Outcome
HST Higher Specialist Training
IBTPHEM Intercollegiate Board for Training in Pre-Hospital Emergency Medicine
ICM Intensive Care Medicine
ICU Intensive Care Unit
IM Internal Medicine
IMT Internal Medicine Training
JRCPTB Joint Royal Colleges of Physicians’ Training Board
MCQ Multiple Choice Question
Mini-CEX Mini-Clinical Evaluation Exercise
NES NHS Education for Scotland
NIMDTA Northern Ireland Medical & Dental Training Agency
OSCE Objective Structured Clinical Examination
PICM Paediatric intensive Care Medicine
RA ICM Regional Advisor
RCoA Royal College of Anaesthetists
RCEM Royal College of Emergency Medicine
RCPCH Royal College of Paediatrics and Child Health
SBA Single Best Answer
SLE Supervised Learning Event
SOE Structured Oral Examination
SSY Special Skills Year
TAQ FICM Training, Assessment & Quality Committee
TPD Training Programme Director

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