ICM Curriculum - 2021/08/04

Sources

• ICM Curriculum Page
• ICM Curriculum 2021 - V1 2021-08-01
• ICM HILLO Competency Mapping with 2010 Curriculum
• ICM High Level Learning Outcomes

These need to be at a capability level three

Tasks = "Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives."

Knowledge = "Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically."

Patient Management = "Can take history, examine and arrange investigations in a more complex case in a focused manner. Can initiate emergency management. In a most cases, can plan management and manage any divergences. May need specialist help for some cases."

1 - The doctor will be able to function successfully within NHS organisational and management systems whilst adhering to the appropriate legal and ethical framework.

Applicable Assessments: ACAT, CBD, MSF, ESSR, FFICM_MCQ, FFICM_SOE

Key Capabilities

• Understand, incorporate and implement national legislation (eg Health and Social Care Act 2012 and the Equality Act 2010 (Disability Discrimination Act 1995 in Northern Ireland)) into everyday practice.
• Successfully and ethically incorporate information technology and governance, according to national legislation, into patient care
• Can communicate & document effectively, according to ethical and legal frameworks to promote the highest standards of healthcare
• Know how to interpret, construct and apply ethical and legal frameworks into all areas of clinical governance
• Demonstrate the highest professional behaviours, individually and corporately
• Continually strive to enhance and integrate knowledge into clinical practice and the NHS organisation as a whole, whilst observing legal and ethical obligations.

Old Curriculum Competency Mapping

• 1.2   Manages cardiopulmonary resuscitation - ALS recommended
• 1.3   Manages the patient post resuscitation
• 1.7   Describes the management of mass casualties
• 2.1 Obtains a history and performs an accurate clinical examination
• 2.7 Monitors and responds to trends in physiological variables
• 2.8 Integrates clinical findings with laboratory investigations to form a differential - diagnosis
• 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
• 3.10 Recognises and manages the patient following intoxication with drugs or environmental - toxins
• 3.11 Recognises life-threatening maternal peripartum complications and manages care
• 4.1 Prescribes drugs and therapies safely
• 4.2 Manages antimicrobial drug therapy
• 4.3 Administers blood and blood products safely
• 4.5 Describes the use of mechanical assist devices to support the circulation
• 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support
• 4.9 Co-ordinates and provides nutritional assessment and support
• 6.1 Manages the pre- and post-operative care of the high risk surgical patient
• 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical - illness for patients and families
• 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives
• 7.5 Manages the safe and timely discharge of patients from the ICU
• 7.6 Co-ordinates patient follow up in hospital
• 7.7 Co-ordinates patient follow up and rehabilitation after hospital discharge
• 8.1 Manages the process of withholding or withdrawing treatment with the multi-disciplinary team
• 8.2 Discusses end of life care with patients and their families / surrogates
• 8.3 Manages palliative care of the critically ill patient
• 8.4 Performs brain-stem death testing
• 8.5 Manages the physiological support of the organ donor
• 8.6 Manages donation following cardiac death
• 9.2 Describes national legislation and guidelines relating to child protection and their - relevance to critical care
• 11.1 Leads a daily multidisciplinary ward round
• 11.2 Complies with local infection control measures
• 11.3 Identifies environmental hazards and promotes safety for patients and staff
• 11.4 Identifies and minimises risk of critical incidents and adverse events, including - complications of critical illness
• 11.6 Critically appraises and applies guidelines, protocols and care bundles
• 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
• 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.3 Maintains accurate and legible records / documentation
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and - treatment
• 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact - on decision making
• 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient - data
• 12.8 Ensures continuity of care through effective hand-over of clinical information
• 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care
• 12.12 Formulates clinical decisions with respect for ethical and legal principles
• 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice
• 12.15 Participates in research or audit under supervision

2 - The doctor will be focused on patient safety and will deliver effective quality improvement, whilst practising within established legal and ethical frameworks.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, MSF, ESSR, FFICM_MCQ, FFICM_SOE

Key Capabilities

• Adhere to national legislation and guidelines relating to safeguarding children and other vulnerable groups of patients, such as those with protected characteristics
• Contribute towards quality improvement, communicate effectively and share good practice
• Optimise care of critically unwell patients by the critical appraisal of recent medical literature and the application of evidence-based guidelines
• Demonstrate a commitment to learn from critical incidents and adverse events as well as sharing the learning points from these experiences Communicate effectively with patients, their families and professional colleagues whilst recognising and effectively managing any barriers to effective communication
• Ensure patient safety is the key priority at all times in their clinical practice both within the intensive care unit and in the wider clinical environment of the hospital

Old Curriculum Competency Mapping

• 9.2 Describes national legislation and guidelines relating to child protection and their - relevance to critical care
• 11.1 Leads a daily multidisciplinary ward round
• 11.2 Complies with local infection control measures
• 11.3 Identifies environmental hazards and promotes safety for patients and staff
• 11.4 Identifies and minimises risk of critical incidents and adverse events, including - complications of critical illness
• 11.5 Organises a case conference
• 11.6 Critically appraises and applies guidelines, protocols and care bundles
• 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
• 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.3 Maintains accurate and legible records / documentation
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and - treatment
• 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making
• 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data
• 12.7 Collaborates and consults; promotes team-working
• 12.8 Ensures continuity of care through effective hand-over of clinical information
• 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care
• 12.10 Appropriately supervises, and delegates to others, the delivery of patient care
• 12.11 Takes responsibility for safe patient care
• 12.12 Formulates clinical decisions with respect for ethical and legal principles
• 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice
• 12.14 Participates in multidisciplinary teaching
• 12.15 Participates in research or audit under supervision

3 - An Intensive Care Medicine specialist will know how to undertake medical research including the ethical considerations, methodology and how to manage and interpret data appropriately.

Applicable Assessments: ACAT, CBD, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Remain up to date in their reading of current research literature and best practice guidelines
• Have an understanding of the processes and governance of clinical research, and will be able to communicate this to patients and their relatives where appropriate
• Be able to critically appraise clinical literature, and to apply this, when appropriate, to their clinical practice
• Use their knowledge of the ethical principles of practising medicine, and the legal framework associated with this in modern healthcare to benefit their patients
• Have the ability to organise the collection and interpretation of data collected from their own intensive care unit and use this as a method of improving clinical services locally
• Apply information derived from population data to help inform individual treatment plans for their patients.

Old Curriculum Competency Mapping

• 11.6 Critically appraises and applies guidelines, protocols and care bundles
• 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist
• 12.12 Formulates clinical decisions with respect for ethical and legal principles
• 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice

4 - To ensure development of the future medical workforce, a doctor working as a specialist in Intensive Care Medicine will be an effective clinical teacher and will be able to provide educational and clinical supervision.

Applicable Assessments: ACAT, MSF, ESSR, FFICM_OSCE, FFICM_SOE

Key Capabilities

Deliver effective teaching and training to medical students, doctors in training, colleagues and members of the wider multidisciplinary team. This will include understanding the teaching, assessment and feedback needs of learners from all groups with protected characteristics and being able to adapt teaching and provide supportive techniques to ensure successful and equitable learning outcomes. - Competently assess the performance of learners objectively and deliver timely and constructive feedback on learning activities in accordance with current educational standards and best practice - Meet any regulatory requirements of a trainer and will keep these current as well as participating in quality assurance processes to ensure excellent undergraduate and postgraduate training - Endeavour to ensure patient involvement and feedback is integral to the delivery of education to doctors in their individual roles as well as their role as a member of the multidisciplinary team.

Old Curriculum Competency Mapping

• 12.2 Communicates effectively with members of the health care team
• 12.7 Collaborates and consults; promotes team-working
• 12.14 Participates in multidisciplinary teaching
• 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice

5 - Doctors specialising in Intensive Care Medicine can identify, resuscitate and stabilise a critically ill patient, as well as undertake their safe intra-hospital or inter-hospital transfer to an appropriately staffed and equipped facility.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Identify an acutely ill patient or one at risk of significant deterioration by taking account of their medical history, clinical examination, vital signs and available investigations
• Integrate clinical findings with timely and appropriate investigations to form a differential diagnosis and an initial treatment plan
• Administer intravenous fluids and inotropic drugs as clinically indicated utilising central venous access where required and monitoring the effectiveness of these treatments with invasive monitoring techniques
• Stabilise and initiate an initial treatment plan for a critically ill acute surgical, acute medical or peripartum patient including those with sepsis or post-trauma and institute timely antimicrobial therapy
• Provide definitive airway management and initiate and maintain advanced respiratory support
• Undertake the transport of mechanically ventilated critically ill patients outside the Intensive Care Unit when required
• Communicate effectively and in a timely manner, with fellow members of the multidisciplinary team including those from other specialties and make an accurate, legible and contemporaneous entry in the patient’s medical record
• Where escalation of care is required, be able to arrange this and provide a succinct structured handover to clinical colleagues
• Recognise when a patient has the potential to deteriorate or requires future treatment escalation and be able to provide explicit instructions regarding an ongoing treatment plan and contact details should a further review be required
• Have the ability to communicate with a patient's family, in terms they can understand, the patient's clinical condition, current and likely future treatment options and where possible, an indicative prognosis in an empathetic and understanding manner
• Be mindful at all times that whilst assessing and treating patients they must maintain optimum safety for their patients by recognising any limitations of their current clinical environment, the available equipment and personnel and employing best practice guidelines where these exist.

Old Curriculum Competency Mapping

• 1.1   Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
• 1.2   Manages cardiopulmonary resuscitation - ALS recommended
• 1.3   Manages the patient post resuscitation
• 1.4   Triages and prioritises patients appropriately, including timely admission to ICU
• 1.5   Assesses and provides initial management of the trauma patient
• 1.6   Assesses and provides initial management of the patient with burns
• 2.1 Obtains a history and performs an accurate clinical examination
• 2.2 Undertakes timely and appropriate investigations
• 2.3 Performs electrocardiography (ECG / EKG) and interprets the results
• 2.5 Obtains and interprets the results from blood gas samples
• 2.6 Interprets imaging studies
• 2.7 Monitors and responds to trends in physiological variables
• 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis
• 3.1 Manages the care of the critically ill patient with specific acute medical conditions
• 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
• 3.3 Recognises and manages the patient with circulatory failure
• 3.4 Recognises and manages the patient with, or at risk of, acute renal failure
• 3.5 Recognises and manages the patient with, or at risk of, acute liver failure
• 3.6 Recognises and manages the patient with neurological impairment
• 3.7 Recognises and manages the patient with acute gastrointestinal failure
• 3.8 Recognises and manages the patient with severe acute respiratory failure / acute lung injury syndromes (ALI / ARDS)
• 3.9 Recognises and manages the septic patient
• 3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins
• 3.11 Recognises life-threatening maternal peripartum complications and manages care
• 4.1 Prescribes drugs and therapies safely
• 4.2 Manages antimicrobial drug therapy
• 4.3 Administers blood and blood products safely
• 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
• 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support
• 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
• 5.1 Administers oxygen using a variety of administration devices
• 5.2 Performs emergency airway management
• 5.5 Performs fibreoptic bronchoscopy and BAL in the intubated patient
• 5.7 Performs chest drain insertion
• 5.8 Performs arterial catheterisation
• 5.9 Performs ultrasound techniques for vascular localisation
• 5.10 Performs central venous catheterisation
• 5.11 Performs defibrillation and cardioversion
• 5.12 Performs transthoracic cardiac pacing, describes transvenous
• 5.13 Describes how to perform pericardiocentesis
• 5.18 Describes Sengstaken tube (or equivalent) placement
• 5.19 Performs nasogastric tube placement
• 5.20 Performs urinary catheterisation
• 6.1 Manages the pre- and post-operative care of the high risk surgical patient
• 6.2 Manages the care of the patient following cardiac surgery
• 6.3 Manages the care of the patient following craniotomy
• 6.4 Manages the care of the patient following solid organ transplantation
• 6.5 Manages the pre- and post-operative care of the trauma patient
• 9.1 Describes the recognition of the acutely ill child and initial management of paediatric emergencies
• 10.1 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU
• 11.2 Complies with local infection control measures
• 11.3 Identifies environmental hazards and promotes safety for patients and staff
• 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.3 Maintains accurate and legible records / documentation
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
• 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making
• 12.7 Collaborates and consults; promotes team-working
• 12.8 Ensures continuity of care through effective hand-over of clinical information
• 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care
• 12.10 Appropriately supervises, and delegates to others, the delivery of patient care
• 12.11 Takes responsibility for safe patient care

6 - Intensive Care Medicine specialists will have the knowledge and skills to initiate, request and interpret appropriate investigations and advanced monitoring techniques, to aid the diagnosis and management of patients with organ systems failure. They will be able to provide and manage the subsequent advanced organ system support therapies. This will include both pharmacological and mechanical interventions.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Initiate, perform, interpret and integrate point-of-care testing, radiological and laboratory investigations with their patient’s clinical findings
• Integrate knowledge, skills and investigations to treat a patient who is deteriorating and institute or escalate organ support therapies
• Perform invasive procedures to aid the diagnosis and management of a critically ill patient, and provide advanced organ-support therapies as well as monitor the effectiveness of these therapies in improving the patient's overall condition
• Use their knowledge, apply their skills, and interpret investigations and advanced therapeutic monitoring data to manage critically ill patients, including safe prescribing practices and advanced organ system support modalities, throughout the course of their critical illness.

Old Curriculum Competency Mapping

• 1.1   Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
• 2.2 Undertakes timely and appropriate investigations
• 2.3 Performs electrocardiography (ECG / EKG) and interprets the results
• 2.4 Obtains appropriate microbiological samples and interprets results
• 2.5 Obtains and interprets the results from blood gas samples
• 2.6 Interprets imaging studies
• 2.7 Monitors and responds to trends in physiological variables
• 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis
• 3.1 Manages the care of the critically ill patient with specific acute medical conditions
• 3.3 Recognises and manages the patient with circulatory failure
• 3.4 Recognises and manages the patient with, or at risk of, acute renal failure
• 3.5 Recognises and manages the patient with, or at risk of, acute liver failure
• 3.6 Recognises and manages the patient with neurological impairment
• 3.7 Recognises and manages the patient with acute gastrointestinal failure
• 3.8 Recognises and manages the patient with severe acute respiratory failure / acute lung injury syndromes (ALI / ARDS)
• 3.9 Recognises and manages the septic patient
• 3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins
• 3.11 Recognises life-threatening maternal peripartum complications and manages care
• 4.1 Prescribes drugs and therapies safely
• 4.2 Manages antimicrobial drug therapy
• 4.3 Administers blood and blood products safely
• 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
• 4.5 Describes the use of mechanical assist devices to support the circulation
• 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support
• 4.7 Initiates, manages and weans patients from renal replacement therapy
• 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
• 4.9 Co-ordinates and provides nutritional assessment and support
• 5.1 Administers oxygen using a variety of administration devices
• 5.2 Performs emergency airway management
• 5.6 Performs percutaneous tracheostomy
• 5.7 Performs chest drain insertion
• 5.8 Performs arterial catheterisation
• 5.9 Performs ultrasound techniques for vascular localisation
• 5.10 Performs central venous catheterisation
• 5.11 Performs defibrillation and cardioversion
• 5.12 Performs transthoracic cardiac pacing, describes transvenous
• 5.13 Describes how to perform pericardiocentesis
• 5.14 Demonstrates a method for measuring cardiac output and derived haemodynamic variables
• 5.15 Performs lumbar puncture (intradural / 'spinal') under supervision
• 5.16 Manages the administration of analgesia via an epidural catheter
• 5.17 Performs abdominal paracentesis
• 5.18 Describes Sengstaken tube (or equivalent) placement
• 5.19 Performs nasogastric tube placement
• 5.20 Performs urinary catheterisation
• 8.5 Manages the physiological support of the organ donor
• 9.1 Describes the recognition of the acutely ill child and initial management of paediatric emergencies

7 - Specialists in Intensive Care Medicine can provide pre-operative resuscitation and optimisation of patients, deliver post-operative clinical care including optimising their physiological status, provide advanced organ system support and manage their pain relief.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Have the knowledge and understanding of the care of patients undergoing a wide range of operative procedures
• Be expert in resuscitating and stabilising patients before and after a wide range of operative procedures including sold organ transplantation
• Have an awareness of and be able to treat the common complications of a broad range of operative procedures including solid organ transplantation
• Lead and contribute to the skill mix of a multidisciplinary team that will deliver the perioperative management of patients undergoing surgical procedures.

Old Curriculum Competency Mapping

• 1.1   Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
• 1.4   Triages and prioritises patients appropriately, including timely admission to ICU
• 2.1 Obtains a history and performs an accurate clinical examination
• 2.2 Undertakes timely and appropriate investigations
• 2.4 Obtains appropriate microbiological samples and interprets results
• 2.5 Obtains and interprets the results from blood gas samples
• 2.6 Interprets imaging studies
• 2.7 Monitors and responds to trends in physiological variables
• 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis
• 3.3 Recognises and manages the patient with circulatory failure
• 3.4 Recognises and manages the patient with, or at risk of, acute renal failure
• 3.6 Recognises and manages the patient with neurological impairment
• 3.7 Recognises and manages the patient with acute gastrointestinal failure
• 3.8 Recognises and manages the patient with severe acute respiratory failure / acute lung injury syndromes (ALI / ARDS)
• 3.9 Recognises and manages the septic patient
• 4.1 Prescribes drugs and therapies safely
• 4.2 Manages antimicrobial drug therapy
• 4.3 Administers blood and blood products safely
• 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
• 5.1 Administers oxygen using a variety of administration devices
• 5.16 Manages the administration of analgesia via an epidural catheter
• 6.1 Manages the pre- and post-operative care of the high risk surgical patient
• 6.2 Manages the care of the patient following cardiac surgery
• 6.3 Manages the care of the patient following craniotomy
• 6.4 Manages the care of the patient following solid organ transplantation
• 6.5 Manages the pre- and post-operative care of the trauma patient
• 7.3 Manages sedation and neuromuscular blockade
• 12.7 Collaborates and consults; promotes team-working
• 12.8 Ensures continuity of care through effective hand-over of clinical information
• 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care
• 12.10 Appropriately supervises, and delegates to others, the delivery of patient care
• 12.11 Takes responsibility for safe patient care

8 - Doctors specialising in Intensive Care Medicine will understand and manage the physical and psychosocial consequences of critical illness for patients and their families, including providing pain relief, treating delirium and arranging ongoing care and rehabilitation. They will also manage the withholding or withdrawal of life-sustaining treatment, discussing end of life care with patients and their families and facilitating organ donation where appropriate.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Identifying and limiting the physical and psychosocial consequences of critical illness for patients and families paying particular attention to the assessment, prevention and treatment of pain and delirium
• Communicating the continuing care requirements of patients at discharge from both ICU and hospital to healthcare professionals, patients and relatives. This will include the patient’s plan for ongoing care, medical follow up and rehabilitation
• Facilitating discussions focused on how to manage end of life care with patients and their families. The process of withholding or withdrawing lifesustaining treatments and providing palliative care whilst maintaining respect for cultural and religious beliefs will form an important element of this
• Diagnosing death using neurological criteria and diagnosing death using circulatory criteria in time sensitive scenarios (eg donation after circulatory death). Identifying likely organ donors, working collaboratively with specialist nurses for organ donation and facilitating the process of organ donation, including providing appropriate physiological support to the organ donor

Old Curriculum Competency Mapping

• 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
• 7.2 Manages the assessment, prevention and treatment of pain and delerium
• 7.3 Manages sedation and neuromuscular blockade
• 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives
• 7.5 Manages the safe and timely discharge of patients from the ICU
• 7.6 Co-ordinates patient follow up in hospital
• 7.7 Co-ordinates patient follow up and rehabilitation after hospital discharge
• 8.1 Manages the process of withholding or withdrawing treatment with the multi-disciplinary team
• 8.2 Discusses end of life care with patients and their families / surrogates
• 8.3 Manages palliative care of the critically ill patient
• 8.4 Performs brain-stem death testing
• 8.5 Manages the physiological support of the organ donor
• 8.6 Manages donation following cardiac death
• 11.6 Critically appraises and applies guidelines, protocols and care bundles
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.3 Maintains accurate and legible records / documentation
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
• 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making
• 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data
• 12.7 Collaborates and consults; promotes team-working
• 12.8 Ensures continuity of care through effective hand-over of clinical information
• 12.10 Appropriately supervises, and delegates to others, the delivery of patient care
• 12.12 Formulates clinical decisions with respect for ethical and legal principles

9 - Intensive Care Medicine specialists will have the skillset and competence to lead and manage a critical care service, including the multidisciplinary clinical team and providing contemporaneous care to a number of critically ill patients.

Applicable Assessments: ACAT, CBD, MSF, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Identifying and limiting the physical and psychosocial consequences of critical illness for patients and families paying particular attention to the assessment, prevention and treatment of pain and delirium
• Communicating the continuing care requirements of patients at discharge from both ICU and hospital to healthcare professionals, patients and relatives. This will include the patient’s plan for ongoing care, medical follow up and rehabilitation
• Facilitating discussions focused on how to manage end of life care with patients and their families. The process of withholding or withdrawing lifesustaining treatments and providing palliative care whilst maintaining respect for cultural and religious beliefs will form an important element of this
• Diagnosing death using neurological criteria and diagnosing death using circulatory criteria in time sensitive scenarios (eg donation after circulatory death). Identifying likely organ donors, working collaboratively with specialist nurses for organ donation and facilitating the process of organ donation, including providing appropriate physiological support to the organ donor

Old Curriculum Competency Mapping

• 1.2   Manages cardiopulmonary resuscitation - ALS recommended
• 1.4   Triages and prioritises patients appropriately, including timely admission to ICU
• 1.7   Describes the management of mass casualties
• 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives
• 7.5 Manages the safe and timely discharge of patients from the ICU
• 7.6 Co-ordinates patient follow up in hospital
• 7.7 Co-ordinates patient follow up and rehabilitation after hospital discharge
• 8.1 Manages the process of withholding or withdrawing treatment with the multi-disciplinary team
• 8.2 Discusses end of life care with patients and their families / surrogates
• 8.3 Manages palliative care of the critically ill patient
• 8.6 Manages donation following cardiac death
• 10.1 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU
• 11.1 Leads a daily multidisciplinary ward round
• 11.3 Identifies environmental hazards and promotes safety for patients and staff
• 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness
• 11.5 Organises a case conference
• 11.6 Critically appraises and applies guidelines, protocols and care bundles
• 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.3 Maintains accurate and legible records / documentation
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
• 12.5 Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making
• 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data
• 12.7 Collaborates and consults; promotes team-working
• 12.8 Ensures continuity of care through effective hand-over of clinical information
• 12.9 Supports clinical staff outside the ICU to enable the delivery of effective care
• 12.10 Appropriately supervises, and delegates to others, the delivery of patient care
• 12.11 Takes responsibility for safe patient care
• 12.12 Formulates clinical decisions with respect for ethical and legal principles
• 12.13 Seeks learning opportunities and integrates new knowledge into clinical practice
• 12.14 Participates in multidisciplinary teaching
• 12.15 Participates in research or audit under supervision

10 - Intensive Care Medicine specialists will have developed the necessary skills of induction of anaesthesia, airway control, care of the unconscious patient and understanding of surgery and its physiological impact on the patient.

Applicable Assessments: CBD, MINICEX, DOPS, MSF, ESSR, FFICM_MCQ, FFICM_OSCE

Key Capabilities

• Conduct comprehensive pre-anaesthetic and pre-operative checks
• Demonstrate knowledge of anatomy, physiology, biochemistry and pharmacology relevant to anaesthetic practice
• Describe the functioning principles of standard equipment used within anaesthetic practice and understand the physical principles governing the operation of such equipment and the clinical measurements derived from them
• Pre-operatively assess ASA 1-3 patients’ suitability for anaesthesia, prescribe suitable pre-medication and recognise when further investigation or optimisation is required prior to commencing surgery and adequately communicate this to the patient and their family
• Safely induce anaesthesia in ASA 1-3 patients and recognise and deal with complications associated with the induction of anaesthesia
• As a member of the multi-disciplinary theatre team, maintain anaesthesia for the relevant procedure, utilise appropriate monitoring and effectively interpret the information it provides to ensure the safety of the anaesthetised patient
• Recognise anaesthetic critical incidents, understand their causes and how to manage them
• Safely care for a patient recovering from anaesthesia and recognise and treat the common associated complications whilst providing appropriate postoperative analgesia (including that via regional and neuraxial blockade), antiemesis and fluid therapies
• Provide urgent or emergency anaesthesia to ASA 1E and 2E patients requiring non-complex emergency surgery
• Identify patients with difficult airways, demonstrate management of the ‘cannot intubate cannot oxygenate’ scenario in simulation, and be familiar with difficult airway guidelines.

Old Curriculum Competency Mapping

• 4.1 Prescribes drugs and therapies safely
• 4.2 Manages antimicrobial drug therapy
• 4.3 Administers blood and blood products safely
• 4.4 Uses fluids and vasoactive / inotropic drugs to support the circulation
• 4.6 Initiates, manages, and weans patients from invasive and non-invasive ventilatory support
• 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
• 4.9 Co-ordinates and provides nutritional assessment and support
• 5.1 Administers oxygen using a variety of administration devices
• 5.2 Performs emergency airway management
• 5.3 Performs difficult and failed airway management according to local protocols
• 5.4 Performs endotracheal suction
• 5.7 Performs chest drain insertion
• 5.8 Performs arterial catheterisation
• 5.10 Performs central venous catheterisation
• 5.15 Performs lumbar puncture (intradural / 'spinal') under supervision
• 5.20 Performs urinary catheterisation
• 6.1 Manages the pre- and post-operative care of the high risk surgical patient
• 6.2 Manages the care of the patient following cardiac surgery
• 6.3 Manages the care of the patient following craniotomy
• 7.2 Manages the assessment, prevention and treatment of pain and delerium
• 7.3 Manages sedation and neuromuscular blockade
• 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives
• 8.2 Discusses end of life care with patients and their families / surrogates
• 9.2 Describes national legislation and guidelines relating to child protection and their relevance to critical care
• 10.1 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU
• 11.2 Complies with local infection control measures
• 11.3 Identifies environmental hazards and promotes safety for patients and staff
• 11.4 Identifies and minimises risk of critical incidents and adverse events, including complications of critical illness
• 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
• 11.8 Demonstrates an understanding of the managerial and administrative responsibilities of the ICM specialist
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.3 Maintains accurate and legible records / documentation
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
• 12.7 Collaborates and consults; promotes team-working
• 12.10 Appropriately supervises, and delegates to others, the delivery of patient care

Other Old Curriculum Notes

• Is able to conduct comprehensive pre-anaesthetic and pre-operative checks
• Demonstrates knowledge of anatomy, physiology, biochemistry and pharmacology relevant to anaesthetic practice
• Demonstrates knowledge of standard equipment used within anaesthetic practice with an understanding of relevant underpinning physics and clinical measurement involved
• Will be able to pre-operatively assess ASA 1-3 patients suitability for anaesthesia, prescribe suitable pre-medication and recognise when further investigation or optimisation is required prior to commencing surgery and adequately communicate this to the patient or their family
• Will be able to safely induce anaesthesia in ASA 1-3 patients, recognise and deal with complications associated with induction
• As a member of the multi-disciplinary theatre team, the doctor will be able to maintain anaesthesia for the relevant procedure, utilise appropriate monitoring and effectively interpret the information it provides to ensure the safety of the anaesthetised patient.
• Recognises anaesthetic critical incidents, understands their causes and how to manage them
• Will be able to safely care for a patient recovering from anaesthesia and recognise and treat the common associated complications and be able to manage appropriate post-operative analgesia, anti-emesis and fluid therapies
• Will be able to provide urgent or emergency anaesthesia to ASA 1E and 2E patients requiring non-complex emergency surgery
• Can identify patients with difficult airways, is able to demonstrate management of the ‘cannot intubate cannot oxygenate’ scenario in simulation, and knows difficult airway guidelines

11 - In order to manage acutely ill patients outside the Intensive Care Unit, an Intensive Care Medicine specialist will have the diagnostic, investigational and patient management skills required to care for ward-based patients whose condition commonly requires admission to the intensive care unit.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, MSF, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Be able to manage an acute unselected take
• Manage an acute specialty-related take
• Be capable of providing continuity of care to medical in-patients, including management of comorbidities and cognitive impairment
• Know how to manage patients in an outpatient clinic, ambulatory or community setting (including management of long-term conditions)
• Have the ability to assess and treat medical problems in patients in other specialties and special cases
• Make an active contribution to the functioning of a multi-disciplinary clinical team including effective discharge planning
• Deliver effective resuscitation and manage an acutely deteriorating patient
• Care for patients who require end of life care as well as those who require palliative care.

Old Curriculum Competency Mapping

• 1.1   Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
• 1.2   Manages cardiopulmonary resuscitation - ALS recommended
• 1.3   Manages the patient post resuscitation
• 1.4   Triages and prioritises patients appropriately, including timely admission to ICU
• 1.5   Assesses and provides initial management of the trauma patient
• 2.1 Obtains a history and performs an accurate clinical examination
• 2.2 Undertakes timely and appropriate investigations
• 2.4 Obtains appropriate microbiological samples and interprets results
• 2.5 Obtains and interprets the results from blood gas samples
• 2.6 Interprets imaging studies
• 2.7 Monitors and responds to trends in physiological variables
• 2.8 Integrates clinical findings with laboratory investigations to form a differential diagnosis
• 3.1 Manages the care of the critically ill patient with specific acute medical conditions
• 3.2 Identifies the implications of chronic and co-morbid disease in the acutely ill patient
• 3.3 Recognises and manages the patient with circulatory failure
• 3.6 Recognises and manages the patient with neurological impairment
• 3.9 Recognises and manages the septic patient
• 3.10 Recognises and manages the patient following intoxication with drugs or environmental toxins
• 3.11 Recognises life-threatening maternal peripartum complications and manages care
• 4.1 Prescribes drugs and therapies safely
• 4.2 Manages antimicrobial drug therapy
• 4.3 Administers blood and blood products safely
• 4.5 Describes the use of mechanical assist devices to support the circulation
• 4.7 Initiates, manages and weans patients from renal replacement therapy
• 4.8 Recognises and manages electrolyte, glucose and acid-base disturbances
• 5.1 Administers oxygen using a variety of administration devices
• 5.7 Performs chest drain insertion
• 5.10 Performs central venous catheterisation
• 5.15 Performs lumbar puncture (intradural / 'spinal') under supervision
• 6.1 Manages the pre- and post-operative care of the high risk surgical patient
• 7.1 Identifies and attempts to minimise the physical and psychosocial consequences of critical illness for patients and families
• 7.2 Manages the assessment, prevention and treatment of pain and delerium
• 7.4 Communicates the continuing care requirements, including rehabilitation, of patients at ICU discharge to health care professionals, patients and relatives
• 7.5 Manages the safe and timely discharge of patients from the ICU
• 8.1 Manages the process of withholding or withdrawing treatment with the multi-disciplinary team
• 11.2 Complies with local infection control measures
• 11.3 Identifies environmental hazards and promotes safety for patients and staff
• 11.7 Describes commonly used scoring systems for assessment of severity of illness, case mix and workload
• 12.1 Communicates effectively with patients and relatives
• 12.2 Communicates effectively with members of the health care team
• 12.4 Involves patients (or their surrogates if applicable) in decisions about care and treatment
• 12.6 Respects privacy, dignity, confidentiality and legal constraints on the use of patient data
• 12.7 Collaborates and consults; promotes team-working
• 12.11 Takes responsibility for safe patient care

12 - Doctors specialising in Intensive Care Medicine understand the special needs of, and are competent to manage patients with neurological diseases, both medical and those requiring surgery, which will include the management of raised intracranial pressure, central nervous system infections and neuromuscular disorders

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Understanding and assessing the perioperative risks associated with patient comorbidities, emergency anaesthesia and surgery and the implications of concomitant drug therapies in these patients
• Being competent in the postoperative care of common acute and chronic medical conditions commonly found in these patients
• Being aware of the effects of major neurological surgery on these patients and the associated immediate postoperative management of these patients including the common complications and providing optimal analgesia
• Knowing the factors which influence the intensity, levels of care and the clinical environments where the necessary care can be safely delivered to patients with neurological disease
• Recognising and treating respiratory and cardiovascular dysfunction with their associated complications commonly encountered in these patients
• Effectively assessing and managing other perioperative conditions and complications encountered by pre- and post-operative neurosurgical and neurological patients
• Being able to competently assess a patient’s neurological status and provide appropriate support where necessary
• Having a thorough understanding of the pathophysiology of raised intracranial pressure including the options for its operative and non-operative management
• Providing immediate treatment of perioperative emergencies in neurosurgical and neurological patients and knowing when to seek senior help and support

Old Curriculum Competency Mapping

• 3.6 Recognises and manages the patient with neurological impairment

Old Curriculum Greater Detail

• Signs and symptoms of neurological impairment
• The toxic, metabolic, structural, and infectious causes of altered consciousness
• Causes, recognition and management of metabolic disorders: Electrolyte disorders; acid-base disorders; fluid-balance disorders; thermoregulation and associated disorders
• Causes, recognition and management of neurological disorders: acute confusional states and coma; post-anoxic brain damage; intracranial haemorrhage and infarction; sub-arachnoid haemorrhage; cerebro-vascular accidents (CVA / stroke); convulsions and status epilepticus; meningitis and encephalitis; medical causes of raised intracranial pressure; acute neuromuscular diseases causing respiratory difficulty (e.g. Guillain- Barre, myasthenia gravis, malignant hyperpyrexia); critical illness polyneuropathy, motor neuropathy and myopathy
• Examine and plan care for the confused patient
• Identify and avoid factors contributing to neurological impairment
• Assess and document Glasgow Coma Scale (GCS)
• Consider potential interactions when prescribing drugs and therapies
• Investigation of impaired neurological function; methods for assessing neurological function (e.g. Glasgow Coma Scale)
• Indications, contraindications and complications of lumbar puncture (see 5.15)
• Indications for urgent imaging of the brain and neurosurgical consultation
• Principles, indications and limitations of electroencephalogram (EEG) and evoked potentials
• Perform a lumbar puncture
• Principles of cerebral perfusion pressure, cerebral oxygen delivery and the methods by which they may be optimised
• Factors and therapies which may influence intracranial and cerebral perfusion pressure
• Aetiology and management of raised intracranial pressure (ICP)
• Principles of management of closed head injury including indications for decompressive craniectomy
• Cerebral spinal fluid (CSF) drainage for raised ICP (lumbar drain and extraventricular drain)
• Coup and contra-coup injuries
• Systems available for intracranial pressure monitoring - indications, principles, type and site of placement of the monitoring device, data collection and trouble-shooting
• Recognise changes in intracranial pressure and cerebral perfusion pressure which are life threatening
• Take prompt action to reduce acutely elevated intracranial pressure
• Manage cardiorespiratory physiology to minimise rises in intracranial pressure
• Use of thiopentone infusions to induce deep coma
• Methods of preventing the 'second insult' to the brain
• Undertake or assist in the insertion and maintenance of an intracranial pressure monitor
• Obtain and interpret data from intracranial pressure monitoring
• Principles of measurement of jugular venous saturation, cerebral Doppler velocities and cerebral blood flow.
• Management of vasospasm
• Indications for plasmapheresis or immunoglobulins in Guillain Barre and myasthenic patients
• Determine when the patient's needs exceed local resources or specialist expertise (requirement for transfer)

13 - A specialist in adult Intensive Care Medicine is competent to recognise, provide initial stabilisation and manage common paediatric emergencies until expert advice or specialist assistance is available. They are familiar with legislation regarding safeguarding children in the context of Intensive Care Medicine practice.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Know and can effectively manage the major anatomical, physiological and psychological differences between adult and paediatric patients
• Appreciate the pathophysiology of common paediatric emergencies, recognise their presentation and can provide initial management until expert help or specialist assistance is available
• Are able to provide emergency and continuing cardiovascular support to a child until expert help or specialist assistance is available
• Are capable of resuscitating a child, know when to seek specialist help and support via their local paediatric retrieval team whose processes they are familiar with
• Are competent to provide elective and emergency airway management and mechanical ventilation to a child including induction of anaesthesia for intubation
• Practise in accordance with national legislation and guidelines relating to safeguarding children in the context of critical care.

Old Curriculum Competency Mapping

• 9.1 Describes the recognition of the acutely ill child and initial management of paediatric emergencies
• 9.2 Describes national legislation and guidelines relating to child protection and their relevance to critical care

14 - Intensive Care Medicine specialists recognise the special needs of, and are competent to provide the perioperative care to patients who have undergone cardiothoracic surgery, including providing pain relief and advanced organ system support utilising specialised techniques available to support the cardiovascular system.

Applicable Assessments: ACAT, CBD, MINICEX, DOPS, ESSR, FFICM_MCQ, FFICM_OSCE, FFICM_SOE

Key Capabilities

• Assessing the perioperative risks associated with these patients’ comorbidities, emergency anaesthesia and surgery and the implications of their concomitant drug therapies
• The postoperative care of common acute and chronic medical conditions commonly found in these patients
• Assessing the implications of the type and site of surgery for these patients’ immediate postoperative management and the potential complications, which they can manage effectively whilst providing optimal analgesia
• Considering the factors which influence the intensity, levels of care and the clinical environments where the necessary care can be safely delivered to these patients
• Treating respiratory dysfunction and complications in these patients
• Treat cardiovascular dysfunction and complications in these patients including understanding advanced monitoring techniques and provision of mechanical circulatory support
• Assessing and managing other perioperative conditions and complications encountered by pre- and post-operative cardiothoracic surgery patients
• Recognising and providing immediate treatment of perioperative emergencies and know when to seek senior help and support.

Old Curriculum Competency Mapping

• 6.2 Manages the care of the patient following cardiac surgery

Old Curriculum Greater Detail

• Knowledge
• Factors determining perioperative risk:
• Importance of preoperative health status on postoperative outcomes Indications for, and interpretation of pre-operative investigations Dangers of emergency anaesthesia and surgery
• Perioperative implications of current drug therapy
• Implications for postoperative care of common acute and chronic medical conditions (see 3.1 and 3.2) Implications of type of anaesthesia (general/regional/local) for perioperative care
• Implications of type / site of surgery for postoperative management and potential complications within the first 24 hours
• of surgery
• Recognition, assessment and management of acute pain
• Indications for and methods of perioperative anti-thrombotic treatment
• Criteria for admission to, and discharge from ICU - factors influencing intensity and site of care (ward, high dependency unit (HDU), intensive care unit (ICU))
• Assessment and management of commonly encountered perioperative conditions and complications including:
• Respiratory:
• Interpretation of symptoms and signs of respiratory insufficiency in the surgical patient; the unprotected airway; upper and lower airway obstruction including laryngeal trauma and oedema; pneumonia, collapse or consolidation, pulmonary infiltrates including acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) and their causative factors; TRALI; pulmonary oedema; pleural effusion, haemo/pneumothorax (simple and tension); use of chest drains; factors affecting patients following thoracotomy, lung resection, oesophagectomy and oro facial surgery
• Management of bronchopleural fistula; post insertion management of tracheal and bronchial stents
• Cardiovascular:
• Interpretation of symptoms and signs of cardiovascular insufficiency in the surgical patient; recognition of bleeding;
• management of hypo/hypertension; pulmonary embolus; cardiac tamponade; surgery for congenital and acquired cardiac disease; management of patients following cardiac surgery (coronary grafting, valve replacement) and aortic surgery (arch, thoracic, abdominal); heart; principles of cardiac pacing
• Management of pulmonary hypertension
• Renal: Causes of perioperative oliguria and anuria; prevention and management of acute renal failure
• Neurological: stroke (CVA); causes of post-operative confusion.
• Gastrointestinal: post-operative alterations in gut motility; perioperative nutrition; post-operative nausea and vomiting
• Haematology and oncology:
• Management of severe acute haemorrhage and blood transfusion, principles of cell salvage; correction of coagulation
• disorders and haemoglobinopathies, care of the immunosuppressed or immunoincompetent patient, complications of chemotherapy and radiotherapy
• Interprets thromboelastography in post cardiac surgical patients
• Metabolic & Hormonal: Blood glucose control; perioperative management of electrolyte disorders
• Sepsis and Infection: fever and hypothermia; postoperative hypoperfusion and impaired oxygen delivery; wound infection; opportunistic and nosocomial infection; perioperative infection risk and prophylactic antibiotics; intestinal ischaemia; antibiotic selection and prescribing
• Management of cyanosis, hypo- and hypertension, hypothermia and shivering
• Surgical interventions in patients with cardiac disease, perioperative management of the cardiovascular surgery patient and potential complications occurring within 24 hours of cardiac surgery
• Skills
• Consider the impact of long-term and chronic treatment on acute surgical care
• Identify pre-operative health status and intercurrent disease, medications, allergies and their interaction with the nature of anaesthetic and surgery
• Obtain relevant information from the patient, relatives and other secondary sources
• Assess conscious level and conduct a careful systems review
• Select and determine adequacy and route of administration of analgesia
• Document, monitor and manage fluid balance, circulating volume, drains, systemic oxygen supply
• Establish a plan for postoperative management
• Identify life-threatening cardiorespiratory complications; manage hypovolaemia and impaired oxygen delivery
• Differentiate and manage tension pneumothorax, cardiac tamponade and pulmonary embolus
• Recognise and manage perioperative emergencies and seek assistance appropriately
• Seek appropriate support and supervision in order to provide optimal patient care
• Interpret pre-operative investigations, intra-operative findings and events/complications, and respond to them appropriately
• Demonstrates management of intra-aortic balloon pump in surgical and non-surgical cardiac patients

Special Skills Year - Academic Research

Aim = "Equip individuals with the competencies to deliver multicentre clinical research within their critical care units following appointment as NHS consultants, and also initiate local research, if individual aspirations and local resources support this"

Unique Assessments = "PbD, Viva Voce"

Notes = "Requires proof of completion of application for funding, GCP certificate, presentation at national research meeting"