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 will need to be managed by deaneries at local levels. Much will depend 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 will 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 may be 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 (see RCoA/FICM joint statement, below) 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 will require novice anaesthetic training equivalent to CT1, and those from Core Anaesthetic Training will 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, it must now be provided ‘in-programme’. This has been 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 will manage the ICM-specific components of the dual programme, such as the medicine requirement. ICM TPDs will 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 HST 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 Joint CCT.