2021 Curriculum learning syllabus: stage 3 special interest areas

Published: 25/02/2021

Additional Intensive Care

6 months (neither group 1 nor group 2)

Learning outcome

Provides safe and effective care for critically ill patients with occasional specialist help and guidance

Key capabilities

A	Recognises the limitations of intensive care; employs appropriate admission criteria FICM Capability level: 3 (see below for details)
B	Performs safely and effectively the clinical invasive procedures required to maintain cardiovascular, renal, and respiratory support FICM Capability level: 3 (see below for details)
C	Recognises, assesses and initiates management for acutely ill adults across the spectrum of single or multiple organ failure FICM Capability level: 4 (see below for details)
D	Recognises the acutely ill child and initiates management of paediatric emergencies FICM Capability level: 3 (see below for details)
E	Recognises and manages the patient with sepsis and employs local infection control policies FICM Capability level: 4 (see below for details)
F	Undertakes and evaluates laboratory and clinical imaging investigations to manage patients while critically ill during their intensive care stay FICM Capability level: 3 (see below for details)
G	Manages the medical / surgical needs and organ support of patients during their critical illness, including the holistic care of patients and relatives FICM Capability level: 3 (see below for details)
H	Plans and communicates the appropriate discharge of patients from intensive care to healthcare professionals, patients and relatives FICM Capability level: 3 (see below for details)
I	Manages end of life care within the intensive care environment with patients, relatives and the multi-professional team FICM Capability level: 3 (see below for details)
J	Liaises with transplant services when appropriate, can perform brain stem death testing and provides the physiological support of the donor FICM Capability level: 2 (see below for details)
K	Supports clinical staff outside the ICU to enable the early detection of the deteriorating patient FICM Capability level: 4 (see below for details)

Examples of evidence

Experience and logbook:

experience in an ICU recognised for stage 3 ICM training including on call commitments
ICU follow up clinics.

Supervised Learning Events (SLEs) can be used to demonstrate:

assessment and management of cases in accordance with capability levels set out above
examples may include management of severe sepsis, multi-trauma, post-operative management following complex major surgery, severe burns, diagnosis of brain stem death and management of the potential organ donor
assessment of acutely ill child including initial resuscitation of paediatric emergencies
practical procedures as listed in key capability B
other practical procedures may include percutaneous tracheostomy, bronchoscopy, use of ultrasound in intensive care including use of echocardiography
ICU Ward round management and discharge planning
Critical Care Outreach review
Communication with relatives including discussion of withdrawal of support.

Personal Activities and Personal Reflections may include:

national or international meetings related to Intensive Care Medicine
presentation at relevant meeting eg abstract or free paper
development of guidelines and policies related to Intensive Care Medicine
leadership of QI projects related to ICM
review of mortality
teaching and training of other medical and nursing staff and allied health professionals
simulation training related to management of critical care scenarios
attendance at debriefing sessions following stressful episodes
leadership training and demonstration of ability to lead ICU ward rounds
attendance at ICU follow up clinics and appreciation of post intensive care syndrome
attendance at ICU business or multidisciplinary meetings
attendance at Trust or Health Board senior management meetings.

Other evidence:

satisfactory MSF.

Cross links with other domains and capabilities

all generic professional domains of learning
General Anaesthesia
Resuscitation and Transfer
Intensive Care

FICM capability levels

Level	Task orientated capability	Knowledge orientated capability	Patient management capability
1	Performs task under direct supervision.	Very limited knowledge; requires considerable guidance to solve a problem within the area.	Can take history, examine and arrange investigations for straight forward case (limited differential diagnosis). Can initiate emergency management and continue a management plan, recognising acute divergences from the plan. Will need help to deal with these.
2	Performs task in straightforward circumstances, requires help for more difficult situations. Understands indications and complications of task.	Sound basic knowledge; requires some guidance to solve a problem within the area. Will have knowledge of appropriate guidelines and protocols.	Can take history, examine and arrange investigations in a more complicated case. Can initiate emergency management. In a straightforward case, can plan management and manage any divergences in short term. Will need help with more complicated cases.
3	Performs task in most circumstances, will need some guidance in complex situations. Can manage most complications, has a good understanding of contraindications and alternatives.	Advanced knowledge and understanding; only requires occasional advice and assistance to solve a problem. Will be able to assess evidence critically.	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.
4	Independent (consultant) practice.	Expert level of knowledge.	Specialist.