Transcript Education as tool for quality improvement From evidence to

Intensive Care Medicine National Recruitment 2013
Tom Gallacher
National Recruitment Lead
Faculty of Intensive Care Medicine
Background
1952
1960s
1970s
1988
Polio epidemics; ventilator units
General ‘intensive therapy’ and respiratory support units
ICS established (SICS & WICS 1991)
Joint Accreditation Committee for Training in Intensive Therapy [JACIT]
1992
1994
1996
1999 June 7th
2000
2001 Feb
2005
Intercollegiate Committee for ICM
ICNARC established, 400K 2-yr grant
Intercollegiate Board for Training in ICM (AoMRCs)
Min Health authorises change to Specialist Medical Order, ICM a Speciality.
Comprehensive Critical Care, Critical Care Networks
Competency-based training programme in ICM approved
DoH Advisor in Crit Care (end 2011); Stakeholder Forum
2009
Seven RCs endorse proposal to establish intercollegiate Faculty of ICM.
2010
GMC rejects Joint-CCT ICM training programme, requires single CCT
2010, Nov
Foundation Board of the FICM
2011 Mar 1st
2012 Aug 1st
GMC review panel conditionally approves ICM single CCT programme
New ICM programme implemented; ICM a primary speciality
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
The Joint-CCT in ICM
• Joint = [ICM + Parent speciality]
• Maximum duration: 33 months
• Administratively, this made ICM a multiple
subspeciality
Submission of Joint CCT ICM programme to PMETB
The solution
Intensive Care Medicine Stand Alone CCT
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
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
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
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 predefined programme
- ICM CCT output would be defined by service needs during training years
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
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
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
GMC Conditional approval of the single
CCT programme in ICM, March 8th 2011
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
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
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
• ACCS:
• CMT:
• CAT:
n (%):
23 (44%)
15 (29%)
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
Training in Intensive Care
Medicine
Summary for COPMeD
February 2013
Collaboration
EU grant
85 NCs
42 countries
National orgs
Survey
Diversity ++
54 ICM training
programmes
Web-based Delphi
5,241 suggestions
535 contributors
>50 countries
Questionnaire
(patients, relatives)
70 ICUs
8 EU countries
ESICM
Div Prof Dev
European
Board ICM
EDIC
Delphi
iteration
Competency
statements on
website
CURRICULUM MAP
Educational Resources
Learning & teaching
Assessment
Descriptors of how
competencies are
assessed in workplace
Syllabus
Knowledge, skills &
attitudes for each
competence
Competencies
Final set of 102
Nominal Group
12 members
169 competency statements
Rating level & importance
How CoBaTrICE was developed: a 6 year project, 2003-06 & 2008-10
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
GMC Approval of single-CCT
ICM programme
October 3rd 2011
Dual CCTs: stepped recruitment
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
ICM Recruitment
Thanks 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
ICM 2012 Recruitment Process and Outcomes
2012
Intensive Care Medicine (ICM)
ST3 National Recruitment 2012
The Recruitment Process
The report aims to detail the ICM National Recruitment process for 2012.
7/6/2012
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
3 ‘Manned’ interview stations
2 ‘Un-manned’ interview stations
Trainees in ICM:
Partner specialities and outcomes
since 2001
What do the new ICM-CCT
programmes look like?
Single CCT programmes in ICM:
Entry from ACCS
Single CCT programmes in ICM:
Entry from CAT
Single CCT programmes in ICM:
Entry from CMT
Academic Training – a strategic priority
ICM Academic Training (England)
Academic Clinical Training in Scotland: http://www.ecat.ed.ac.uk/
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...
Examination & Assessment
Chair of Examiners: Prof Nigel Webster
Deputy 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
ICM Workforce Planning
ICM an increasingly popular choice at
undergraduate level
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
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
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.