Intensive Care Medicine National Recruitment 2013

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

2. Background

3. ICM: the first speciality to produce a comprehensive competency-based training programme: Feb 2001 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

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 8th 2011

15. GMC Conditional approval of the single CCT programme in ICM, March 8th 2011 • 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. 2012 ICM recruitment outcomes • 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%) • 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. Training in Intensive Care Medicine Summary for COPMeD February 2013

22. CURRICULUM MAP Collaboration EU grant 85 NCs 42 countries National orgs ESICM Div Prof Dev Educational Resources Learning & teaching European Board ICM Assessment Descriptors of how competencies are assessed in workplace Survey Diversity ++ 54 ICM training programmes EDIC Syllabus Knowledge, skills & attitudes for each competence Delphi iteration Competency statements on website • Web-based Delphi • 5,241 suggestions • 535 contributors • >50 countries Competencies Final set of 102 Nominal Group 12 members 169 competency statements Rating level & importance • Questionnaire (patients, relatives) • 70 ICUs • 8 EU countries How CoBaTrICE was developed: a 6year 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 1st and 2nd 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 programmeOctober 3rd 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 RecruitmentThanks to West Midlands Deanery for exemplary support in hosting ICM recruitment 1st 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 1st round. 2nd round May 1st & 2nd 2013: • 94 new posts (including 10 military) • Thanks to COPMeD for this support

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

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 & AssessmentChair of Examiners: Prof Nigel WebsterDeputy 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 9th 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.