Dual CCTs Queries

The GMC do not recognise any such entity as *a* Dual CCT. There are Dual CCTs. There is the opportunity for trainees who wish to train in ICM to also concurrently train in another CCT specialty. These curricula and their respective recruitment and assessment processes are completely independent of each other, but as a result of common competencies shared by the curricula the total training time can be shortened by virtue of a Dual CCTs Programme. It cannot be emphasised enough that it is the programme that is dual. There is a commonly held misconception that trainees can be appointed to a Dual CCT: this is not the case. A trainee must be appointed to both primary specialty programmes which lead to a CCT in fair and open competition according to their suitability to train in that specialty as laid down in the eligibility criteria of the respective curriculum and according to that specialty’s selection process.

The RCoA have relased an FAQ on this on their website:*

"Trainees who accept an ICM NTN starting in August 2020, and who wish to subsequently apply to dual train with anaesthetics, will need to access ‘top-up’ posts to gain the additional training required to complete Stage 1 of the new curriculum, in order to be eligible to apply for ST4 (Stage 2) posts in anaesthetics. We expect that these posts will take the form of Out Of Programme (OOP) posts after commencement of the ICM programme.

The RCoA will continue to work with stakeholders including the Faculty of Intensive Care Medicine, HEE and its equivalents in the devolved nations, Postgraduate Deans, the GMC and the BMA to try to ensure that these posts offer fair terms and conditions (including pay) for those who need to access them.

We will release further information as soon as agreement has been reached around the exact nature of these ‘top-up’ posts and how they will accessed.

It is also worth noting that dual training programmes can only be developed once all of the corresponding new curricula have received GMC approval."

If you have specific questions regarding this you can contact the RCoA training team via email at 2020cct@rcoa.ac.uk

*Information updated 15 January 2020*

The indicative minimum timeframe for Dual CCTs with ICM and a partner specialty is 8.5 years. This is 18 months longer than standalone ICM CCT training (7 years ) and 12 months longer than the previous Joint CCT system (7.5 years). Please see the Dual CCTs guidance documents.

Acute Medicine, Anaesthetics, Emergency Medicine, Renal Medicine and Respiratory Medicine. The Dual Programme Guidance is available on the Dual CCTs page. Further specialities may have Dual Programme agreements developed over the coming months.

Yes. It is possible to subspecialise in PICM as a Dual CCT trainee. Please see section 3.5 (p.18)of the 2021 ICM curriculum

Please follow these links for further details and support.

1. Information for Anaesthetists and Paediatricians

2. RCPCH - Information on PICM subspecialty recognition as a FICM trainee

3. RCPCH - Information on applying for GRID training 

Please see the information on the Recruitment pages of the website.

The Faculty and the College appreciates the difficulties Dual CCTs Programmes may lead to for TPDs and Deans. Entry into the standalone ICM is entirely open to any trainee who has completed one of the designated Core programmes – these appointments are not ‘badged’. Whilst you may get four ICM doctors with a CAT background in one year, in a second year you may get four with a CMT background (although naturally fluctuations of this kind are extremely unlikely).

The concept of ‘badging’ posts does not fit in well with the principles of fair and open competition on which the entirety of specialist medical recruitment is now predicated. In a system of ‘badged’ posts, the programme is set and the trainees are recruited according to programme availability. For example, a dual programme consisting of Anaesthesia and ICM would only be able to recruit doctors into ICM training who already possess an NTN in Anaesthesia. This would exclude doctors with a physician or emergency medicine background from applying for training in ICM, even though those candidates may have scored higher in interview than anaesthetic trainees who finished below them, but were offered ST3 posts in ICM because there were a greater number of Anaesthetic/ICM programme vacancies. Under those circumstances we could end up not recruiting the most suitably qualified doctors to ICM. See the Recruitment pages for more information.

Doctors are able to apply for either specialty first and it is expected doctors may apply for both at the same recruitment episode in order to increase their appointment opportunities. They will, however, in the event of being successful at both interviews have to choose one or other specialty. It will be down to local regions to advise their applicants based on their individual circumstances about which specialty they should apply for first.

Yes. The Faculty has agreed with COPMeD and the DH that the two CCTs should be undertaken in the same Deanery.

Yes. To support workforce planning in intensive care, it is vital that ICM has its own set of National Training Numbers.

NTNs are, in essence, merely identifiers of how many trainees exist in each specialty. Therefore, whilst a Dual CCTs trainee would hold two NTNs, they would not need to use both of them. As long as both are allocated, one NTN would simply be greyed out against their name. For practicalities of delivery, the FICM recommends that whichever specialty the trainee enters first, be it ICM or the partner specialty, that particular NTN be used on their documentation throughout training.

When trainees are undertaking modules of full-time ICM, they will fall under the remit of ICM trainers, and vice-versa for the partner specialty. ICM trainers and TPDs will also assume responsibility for the planning of Dual trainees’ complementary modules, as dictated by the individual trainee’s requirements after completing their respective Core training (i.e. medicine for CAT trainees, anaesthesia for CMT trainees), whilst working with their partner specialty TPD counterparts to arrange the timing of those modules within the overall Dual Programme. In those areas where competencies are dual counted, such as neuro anaesthesia for ICM/Anaesthesia Dual CCTs programmes, trainees may remain under the remit of the Anaesthesia trainers; however it will be up to those trainees to ensure that the relevant assessments are completed and portfolios maintained to demonstrate the acquisition of both curriculums’ competencies as part of the ARCP process.

No. The FICM and its partner colleges have agreed to each accept the other’s WPBA materials as part of the dual counting of assessments. Trainees will be expected to maintain individual portfolios for each programme demonstrating achievement of each curriculum’s learning outcomes.

This is managed by deaneries at local levels. Much depends on whether the difficulties in question are purely anaesthetic or ICM related. If the problems occur in those areas where competencies overlap, the respective Training Programme Directors need to work together to resolve the problems.

Each region can by default only ever have as many Dual CCTs as it has single ICM posts. The dual element may come from an ICM ST3 trainee applying for a CCT post in a partner specialty, or vice versa from a trainee who is for example already ST3 in anaesthesia applying for one of the advertised ICM posts.

The Faculty and RCoA have structured the requirements of Dual CCTs Programmes to be as flexible as possible to deliver at local level, and it will be necessary for Anaesthesia and ICM TPDs to work very closely together to plan rotations. There will of course be gaps in rotations (there always are) but these will be identifiable in advance and can be planned for; an Anaesthesia TPD will know that in the event of one of his ST3 Anaesthetists being successful in applying for one of the two standalone ICM CCT posts in his region, that this trainee will leave his rotations for 12 months of medicine training. However, as discussed above, the requirements of Stage 1 ICM are not linked specifically to ST years, so there will be room within the combined programme for the two TPDs to arrange movement of trainees through the units. In addition, once the trainee has achieved the requirements of Stage 1 ICM, the degree of dual-counting and competency overlap between the two curricula mean that any such movement will be minimal.

Gaps in rotations are managed by various methods. Deaneries will manage the amount of Dual CCTs Programmes in their regions to best ensure a consistent supply of trainees. Alternatively, as each CCT is fully funded and combining the programmes will result in a saving, there should be funding available for LAT appointments to fill gaps. It will be necessary for Anaesthesia and ICM TPDs to work very closely together to maintain rotations.

No. Candidates entering the ICM programme from Core Medical Training require novice anaesthetic training equivalent to CT1, and those from Core Anaesthetic Training require training in medicine. Whereas with the old Joint-CCT programmes this ‘complementary’ speciality training was often accessed by using training slots in anaesthesia or medicine, since the advent of the standalone ICM CCT in 2012, this training must provided ‘in-programme’. This was made clear in a 2011 joint statement by the RCoA and FICM, which was circulated to both COPMeD and the Deanery Business Managers prior to the regions submitting their post numbers for ICM 2012 recruitment. ICM TPDs manage the ICM-specific components of the dual programme, such as the medicine requirement. ICM TPDs also work closely in tandem with anaesthetic TPDs in the planning and organisation of Dual CCTs Programmes to meet the learning outcomes required of both curricula.

The Faculty advises that, as should be the case currently, out-of-hours experience be anchored by the location of the in-hours training. Thus, when doing anaesthesia, the OOH experience would be in anaesthesia, and vice versa for ICM. For those modules which are dual counted, trainees must fulfil the curriculum competency requirements for both specialties and OOH work is intrinsic to both areas. For example, experience in neuro anaesthesia will often include experience in neuro ICM, and the on-call may therefore be experienced in both. The detail should be agreed by the respective speciality Tutors, with referral to the regional training committees if in doubt. In the event of disagreement which cannot be resolved, the default would be 50:50. It is accepted that in some hospitals trainees undertaking blocks of anaesthesia may be required to cover the ICU on-call as a function of service requirements.

The Faculty is currently undertaking significant workforce planning in conjunction with the RCoA and CfWI (Centre for Workforce Intelligence). It is envisaged that, certainly in the early days of the new CCT programme, the vast majority of trainees will opt to apply for Dual training. At the present time ICM is perceived by CfWI as a specialty where an increase in CCT holders will be required.

Whilst such trainees would indeed have to remain solely in ICM training, it is highly unlikely that this eventuality would occur. Trainees already in one partner specialty applying to enter the other with over a year of experience are likely to be very strong candidates; this would be analogous to ACCS (Anaesthesia) trainees applying for ST3 Anaesthesia, who do not suffer in comparison to CAT applicants. Equally, trainees are not entitled to dual training – they must apply for each component in open competition, as with any primary specialty. This was precisely the case with the old Joint CCT in ICM and has continued under the standalone programme.

Trainees undertaking blocks of ICM outside of the ICM CCT programme are expected to register as Affiliate Trainees of the Faculty. If the trainee entered HST before August 2012, they are expected to demonstrate that they have undertaken training commensurate to Intermediate level ICM as defined by the Joint CCT in Intensive Care Medicine curriculum. If the trainee entered HST after August 2012, they are expected to demonstrate that they have undertaken training commensurate with Stage 1 level ICM as defined by the standalone CCT in Intensive Care Medicine curriculum and as detailed in this guidance. Such trainees could then apply for Affiliate Fellowship of the Faculty (no post nominals). If these Affiliate Fellows then wished to undertake further training to Stage 2 level, they could sit the FFICM Final examination for full Fellowship of the Faculty, with the post nominals FFICM.