1. Intensive Care Medicine National Recruitment 2013 Tom Gallacher National Recruitment Lead Faculty of Intensive Care Medicine

2. Background 1952Polio epidemics; ventilator units 1960sGeneral ‘intensive therapy’ and respiratory support units 1970sICS established (SICS & WICS 1991) 1988Joint Accreditation Committee for Training in Intensive Therapy [JACIT] 1992 Intercollegiate Committee for ICM 1994 ICNARC established, 400K 2-yr grant 1996Intercollegiate Board for Training in ICM (AoMRCs) 1999 June 7 th Min Health authorises change to Specialist Medical Order, ICM a Speciality. 2000Comprehensive Critical Care, Critical Care Networks 2001 Feb Competency-based training programme in ICM approved 2005DoH Advisor in Crit Care (end 2011); Stakeholder Forum 2009Seven RCs endorse proposal to establish intercollegiate Faculty of ICM. 2010GMC rejects Joint-CCT ICM training programme, requires single CCT 2010, NovFoundation Board of the FICM 2011 Mar 1 st GMC review panel conditionally approves ICM single CCT programme 2012 Aug 1 st New ICM programme implemented; ICM a primary speciality

3. THE CCST IN INTENSIVE CARE MEDICINE Competency-Based Training and Assessment PART I A reference manual for trainees and trainers Revisions and comments: This version of the training programme is valid for 2001. It will be reviewed annually. Comments on the training programme are welcome, and should be directed to the chair of the ICBTICM ICM: the first speciality to produce a comprehensive competency-based training programme: Feb 2001

4. The Joint-CCT in ICM Joint = [ICM + Parent speciality] Maximum duration: 33 months Administratively, this made ICM a multiple subspeciality

5. Submission of Joint CCT ICM programme to PMETB

6. The solution

7. Entry from CAT, ACCS or CMT Why plurality? – ICM Primary specialty – Founding principle in the curriculum – Selects the best doctors for Intensive Care Medicine – Permits future changes to the shape of the workforce Intensive Care Medicine Stand Alone CCT

8. Why not appoint to both primary specialties in the same recruitment round? – 5 partner specialties and 14 Deaneries – UK Offers system is designed to prevent trainees holding more than 1 offer – Desirable to limit dual programmes to a single UoA – Trainees have time to consider their career choices

9. Why not have pre-defined dual programmes (“badging”)? - Primary specialties and their CCT curricula are independent - Programmes are dual since they contain competencies common to both specialties curricula - Appointment to a primary specialty is according to that specialty’s selection criteria

10. Why not have pre-defined dual programmes (“badging”)? - Specialty selection processes must select the best candidates for that specialty only - Impossible to rank candidates if we try to combine scores from different selection processes - Smaller specialties may have no access to ICM training due to lack of availability of a pre- defined programme - ICM CCT output would be defined by service needs during training years

11. Worked example- pre-defined ICM/anaesthesia dual programme - Applicants from ICM or from anaesthesia ST3 - ICM trainees have anaesthesia interview and anaesthesia trainees have ICM interview - Each specialty selection process will have a highest ranked candidate - Which trainee do we appoint? - Specialty selection processes are not comparable since their criteria, format and content differ – apples and oranges - A second “decider” interview is not fair since appointment to the second primary specialty would not be according to the criteria used to select all other successful trainees

12. Dual CCT’s Programme ICM and one of five partner specialties –Emergency medicine –Acute medicine –Anaesthesia –Respiratory medicine –Renal medicine Common competencies mean duration of the dual programme is not the sum of the individual competencies Competencies gained in one programme can count towards the other It is the programme that is dual not the CCT’s – these are separate and independent

13. Dual CCT’s Programme –Need to be successfully appointed to a programme in ICM and one of the partner specialties in different recruitment episodes –Can only apply for a second programmes in same Deanery –No seniority limit for application to dual programmes in 2013 –If commence 2nd programme within 18 months of first then dual CCT’s –If greater than 18 months delay then CESR (CP) for second programme

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

15. ICM now a primary speciality, like any other primary speciality Unlike any other primary speciality, we wished to retain strong links with multiple partner specialities (previously ‘parent’ specialities) This required clarification of the mechanisms for appointment to, and of the conduct of, Dual CCTs, taking into account equity and equal opportunity of access for trainees from these partner specialities

16. Key GMC condition: Equity and equal opportunity of access Implication: Plurality of access ICM training posts should be accessible by the best candidates regardless of partner speciality Hypothecation / badging of ICM posts not possible ‒not equitable ‒national recruitment process cannot accommodate

17. 72 new posts for E&W: 127 applications 124 met essential criteria 114 attended for interview 86 candidates considered appointable 52 offered & accepted posts (quality ranking) 52 appointees: Source n (%): ACCS:23 (44%) CMT:15 (29%) CAT:14 (27%) 111/114 candidates feedback: Intended Destination n(%): Single CCT ICM:5 (4.5%) Dual CCTs:84 (75.5%) No response:22 (20%) 2012 ICM recruitment outcomes 85 candidates had also applied to another speciality: Anaesthesia:54 (63%) Resp Med: 10 (11.7%) Acute Medicine 9 (10.5%) Emergency medicine 5 (5.8%) Ologies: 7

21. Summary for COPMeD February 2013 Training in Intensive Care Medicine

22. CURRICULUM MAP Survey Diversity ++ 54 ICM training programmes Web-based Delphi 5,241 suggestions 535 contributors >50 countries Questionnaire (patients, relatives) 70 ICUs 8 EU countries Collaboration EU grant 85 NCs 42 countries National orgs Nominal Group 12 members 169 competency statements Rating level & importance Delphi iteration Competency statements on website Syllabus Knowledge, skills & attitudes for each competence Assessment Descriptors of how competencies are assessed in workplace Educational Resources Learning & teaching ESICM Div Prof Dev European Board ICM EDIC Competencies Final set of 102 How CoBaTrICE was developed: a 6 year project, 2003-06 & 2008-10

23. Discussions with COPMeD, GMC, Trustee Colleges, Trainers Stepped recruitment accepted as best approach: – 18 month window between appointment to 1 st and 2 nd CCT – Avoids risk of appointment to separate Deaneries / UoAs for each CCT – Ensures top-ranked candidates appointed Not feasible with concurrent independent recruitment – Allows trainees time to ‘settle in’ to first CCT – Allows trainers time to plan, review trainee progress

24. GMC Approval of single-CCT ICM programme October 3 rd 2011

25. Dual CCTs: stepped recruitment

26. Recruitment key points ICM now a primary speciality – like any other – Parent specialities now partner specialities – Therefore independent recruitment processes Multidisciplinary ethos: hence Dual Programmes negotiated with GMC – Stepped appointment – 18 month window – CESR-CP after 18 months Single CCT-ICM does not mean that trainees can only be intensive care specialists – dual CCTs permits practice in both specialities This addresses the concern that the new programme might produce specialists for which there were too few consultant posts. Workforce planning in progress to determine current and future balance between training numbers and available consultant posts

27. ICM Recruitment Thanks to West Midlands Deanery for exemplary support in hosting ICM recruitment 1 st round April 2012: 72 new posts offered by Deaneries for 2012 – a significant achievement National recruitment process developed and interview panels trained within a few months Scotland and Northern Ireland would retain local processes for 1 st round. 2 nd round May 1 st & 2 nd 2013: 94 new posts (including 10 military) – Thanks to COPMeD for this support

28. March 11 th 2013: Recruitment opens May 1 st & 2 nd : Interviews: Birmingham City Football Ground Special thanks to: Tom Gallacher, Alison Pittard, Manjit Kaur, Daniel Waeland, James Goodwin, FICM-RAs & West Mids Deanery ICM 2012 Recruitment Process and Outcomes

29. 3 ‘Manned’ interview stations

30. 2 ‘Un-manned’ interview stations

31. Trainees in ICM: Partner specialities and outcomes since 2001

33. What do the new ICM-CCT programmes look like?

34. Single CCT programmes in ICM: Entry from ACCS

35. Single CCT programmes in ICM: Entry from CAT

36. Single CCT programmes in ICM: Entry from CMT

37. Academic Training – a strategic priority

38. ICM Academic Training (England) Academic Clinical Training in Scotland: http://www.ecat.ed.ac.uk/

39. Dual Programmes: ICM + partner specialities Entry from Anaesthesia and from Resp Med shown on next slides – other examples available for EM, AIM, Renal Med. Other partnerships possible but not yet worked out. Dual CCTs prolong training by 18 months – Longer might be required for other partner specialities Two examples on next slide...

42. Examination & Assessment Chair of Examiners: Prof Nigel Webster Deputy Chair: Dr Andrew Cohen Two-part Fellowship exam – Part I can be primaries from FRCA, MRCP, MCEM... Or basic level MCQ for ICM primary spec prog – Part II: MCQs; Clinical-OSCEs/Vivas Exam window: ST5-6. Required to pass to ST7 First sitting: Jan 9 th 2013: 82 candidates Pass rate for MCQ: 75% Annual Review of Competence Progression: – Two structured case histories each year, ST1-5 – Higher degree or publications used as evidence – E-portfolio in development 2013 Links with European Diploma of ICM – for consideration

43. ICM Workforce Planning

47. ICM an increasingly popular choice at undergraduate level

48. Advanced Critical Care Practitioners Will provide essential ‘middle tier’ support in the ICU, and likely to contribute substantially to quality improvement and reliability of care Curriculum first draft completed (Anna Batchelor, Graham Nimmo) Quality assurance: – portfolio assessment & certification initially – Examination planned longer term Practitioner membership of the Faculty Working group to become Programme board with ACCP involvement and ownership

49. Workforce Planning Actions: 300 ICM training posts required each year now to maintain current (2013) workforce Aim for 600 by 2023 May require 900 by 2035 Modelling required to include national reconfiguration of NHS – working with CfWfi and Trustee colleges Develop undergraduate training in ICM and ACCP programmes

50. Summary ICM a primary speciality Multidisciplinary ethos – dual CCTs – Administrative arrangements manageable with prior planning Increasingly popular speciality choice for undergraduates as well as postgrads Service demand will increase substantially over next 20 years Workforce planning this year will provide more secure estimates of expansion required Thanks to COPMeD for their support.