Recruitment into ICM is all managed via ICMNRO – see icmnro.wm.hee.nhs.uk

The number of posts available each year fluctuates but is usually between 6 and 10.

Once you have accepted an offer from ICMNRO then please contact the TPD as soon as possible – this is important to start planning your placements in the region.

As you can enter ICM from different core training programmes then your needs in stage 1 can vary – eg if you have completed core medicine then we arrange a year of anaesthesia training. However if you have completed ACCS Anaesthesia then you may only need further time in ICM.

This question is frequently asked!! There is some variation nationally on how this works, and it depends on your background experience, available placements and evidence of learning (eg SLEs, ES reports, MSFs).

Our approach in Severn really depends on you! Once you have an offer in Severn then please discuss with the TPD, and we will arrange the placements that you need to complete stage 1 training.

There are a number of things to get done before starting.

Please contact the TPD to arrange your training placement.

You must register with FICM – see the FICM onboarding webpage. https://www.ficm.ac.uk/trainingexamstrainees/onboarding-for-new-icm-cct-trainees.

This is to allow you access to the LLP, plus other benefits.

Your NTN number is assigned by NHSEWTE, not by FICM. The registration form does ask for this, but you have to leave it blank until you have received it from NHSWTE. Once you have this then you must contact FICM to inform them.

We recommend joining the Intensive Care Society – they offer a number of benefits and discounts on good conferences.

It is a good idea to login into LLP and start to become familiar with it before you start in your first placement.

We hold a school induction in August each year to welcome people to the school, introduce ourselves and cover some important info on processes such as study leave, teaching, learning and assessments, ARCPs.

The ICM training programme follows the 2021 ICM curriculum. It is split into 3 stages:

Stage 1 is a minimum 4 years, consisting of a year each of ICM, Anaesthesia, Medicine (which includes EM), plus one year of additional training in one of these subjects.

If you have experience before ICM entry then we do count that – depending on what you have achieved during that time.

We usually try to place people in the same hospital for the majority of stage 1 training, but it will depend on what you need. It is also a good opportunity to work in more than one hospital and ICU, as this can bring a wealth of experience and knowledge.

For people who need to complete a year of medicine (ie have done core anaesthesia prior to ICM recruitment) then we try to provide a placement that meets your needs best. This is done by discussion with the TPD, and will be based on your previous experience and preferences, as far as possible.

You can sit the written parts of the FFICM exam in stage 1.

Stage 2 consists of a year of specialist modules in cardiac, paediatric, neuro and general ICM.

The other year is either spent in your dual partner specialty, ordoing a SSY for single-CCT trainees.

We offer a wide range of SSYs, and have a good track record of providing well above the curriculum requirements.

Some examples of SSYs done previously are:

- Neuro SSYs – trainees spend a year in Southmead hospital, learning the skills required in tertirary neuro critical care and major trauma.

Recently trainees have also completed significant QI or service development projects, such as introducing continuous EEG monitoring, or looking at advanced techniques for ICP monitoring.

- Cardiothoracic SSY – trainees spend a year in UHBW, between the cardiac and general ICUs. Here they gain more competence in delivering CTICM, including for complex cardiac and thoracic patients. There is ample opportunity to learn echocardiography skills, and all trainees have gone on to gain a formal echo qualification.

- Echocardiography SSY – we have an excellent track record in providing this SSY, and all of our regional hospitals can support this. There is also opportunity to develop TOE skills and experience.

- QI SSY – this can be done in any of our ICUs in the region. Trainees can choose which area they wish to develop as a QI project, depending on their personal choice and what fits with the unit. We have combined this with a formal QI fellowship recently which allowed the trainee to gain a PGCert in patient safety during their SSY.

- Education SSY – this can be delivered in all of our hospitals. Trainees have previously contributed to the ICM training programme, or focused on undergraduate teaching in a unit. There is opportunity to gain postgraduate qualifications in education too within the region.

- Transfer SSY – We are fortunate to have a specific critical care transfer service in the region – Retrieve.

Trainees spend 50% of time in each of a general ICM and Retrieve, gaining skills and experience in transfer medicine. There is also ample opportunity to develop and deliver good QI, service development or educational projects during this time.

- ECMO SSY – UHBW now has a commissioned ECMO service and we are able to offer this SSY to trainees in our region. This is an excellent way to learn the knowledge and skills required for ECMO, both for future work in an ECMO centre or in a referring hospital.

Stage 3 ICM training is all about preparation for a Consultant post.

Trainees still learn a significant amount of clinical ICM, but every unit aims to deliver the experience and learning to enable a smoother transition into a Consultant.

This is done by leading ward rounds in each unit, plus exposure to some of the non-clinical work of a Consultant, including flow management, team leadership, liaison with other teams, increased exposure to governance systems, quality improvement, research or management.

The on calls are structured as non-resident on calls, as Consultant shifts are – this is to enable you to develop skills in managing critically ill patients and the resident medical team from home.

We welcome all trainees into ICM in Severn.

We work closely with the dual partner specialties to try and make your training experience as smooth as possible.

In 2023, approximately 50% of trainees in our programmewere dual ICM-anaesthesia trainees, approximately 20% single ICM CCT trainees, plus 30% dual EM or medicine specialties.

If you are dual training it is really important to keep both the ICM TPD and the partner specialty TPD up to date with any training plans!!

We have a full regional teaching programme, which delivers teaching both for the FFICM exam and for post-FFICM trainees.

It is run on a rolling 18-month curriculum to allow good coverage of all topics before sitting the FFICM exam. It is usually coordinated by stage 3 trainee in each hospital, delivering both topics for the exam plus material for added interest. We have a good mix of internal lectures and external speakers coming, usually leaders in their field.

We also incorporate 2 wellbeing days per year into the teaching programme – these are essential to allow ICM trainees to catch up, network and debrief as you go.

They are usually based around an outdoor activity inclusive for all, and then lunch nearby.

Trainees have previously taken their children, dogs, family members along!!

There are a wide range of courses and conferences available in Severn for general ICM and specific topics.

SICOWE

SPPICE

Communication course

FUSIC heart

Difficult Airway Rescue Techniques

Bristol Severe Acute Respiratory Failure

Focused TOE

One Heart

All ICM trainees will have an ICM educational supervisor – these are allocated by the Faculty Tutor in each hospital so please contact them if you are uncertain who your supervisor is.

When ICM trainees are doing other subjects (eg year of medicine/ anaesthesia in stage 1, or time in a partner specialty) then you should still have an ICM supervisor to check in with from time to time. Contact the Faculty Tutor if you are unsure (details above).

The FICM LLP gives access to all the ICM assessments, and structure of what is needed in each stage. The ARCP process covers all the requirements for revalidation with the GMC.

Trainees will have an ARCP each year, even if they are moved around to accommodate longer periods of leave (egOOPs, maternity leave).

We have developed a Severn region ARCP checklist, to be used in conjunction with the information provided by FICM. This is mainly to give an idea of what is expected, plus some ideas of how to add evidence appropriately. This is attached below.

We also hold career progression meetings at the time of your ARCP. These are the best time to catch up with TPDs and the ARCP panel and we strongly encourage all trainees to attend.

We strongly encourage trainees to consider taking an OOP during your training.

It is not compulsory but can be useful, especially if time is spent working in ICM in another region or country.

OOPE is used for time purely to gain experience.

OOPT is used if you wish that time to count towards your CCT – this will needs discussion with TPD to agree how it can be counted.

OOPC is a career break – similar to OOPE but can be used as training time if relevant.

OOPR is done for time in research – usually towards a higher research degree.

Some recent examples of OOPS taken are:

- 6 months in Sydney, gaining experience in pre-hospital and transfer medicine, plus time in General and Cardiac ICM

- Undertaking a Sustainable Healthcare fellowship in Brighton, working towards a PhD application

- Working in Starship Children’s Hospital, Auckland, NZ – and then some time travelling before returning to UK

- Undertaking an OOPR to do a PhD in the host response to sepsis

- To enable time to work in New Zealand, plus time for travelling

- To enable completion of a PhD in ICM in low resource countries – working in Malawi for 3 years.

- To allow a single CCT trainee additional time doing anaesthesia as their area of specialist interest

These are short periods of time (taken from study leave allowance) which allow trainees to visit other units to gain experience which cannot be gained during the training programme in this region.

They are usually 1 week but can be 2.

There is the ability to apply for some funding for subsistence during this time.

These are excellent opportunities to gain some experience in a specialist area!!!

Some examples are:

- Visiting the toxins unit in Edinburgh ICU.

- A Liver fellowship in King’s College Hospital

- To gain some dedicated TOE experience to undertake the focused TOE qualification.

If you wish to undertake a microfellowship please discuss with the TPD in the first instance.

Working in medicine can be difficult at times, even when things are going well.