1. Introduction to Intensive Care Medicine for ACCS trainees Sabine Eggert Swansea 2012

2. Intensive Care Medicine Copenhagen 1952 – Ibsen: Technique of positive pressure ventilation widely adopted in polio epidemic with mortality reduction from 90% to 25%. (Manpower required - 1400 students) Positive-pressure ventilators developed (Engstrom)

3. Intensive Care Medicine

4. 1970–1980s – modern concept of critical illness developed. Respiratory support only run by anaesthetists 1999 - Awarded specialty status 2000 - IBITCM established 2002 - Dual CCT in ICM 2010 - FICM approved 2012 - Single CCT in ICM

5. Intensive Care Medicine

6. Principles Diffusion (Ficks law) Filtration Absorption

7. Intensive Care Medicine Change over time: Equipment Environment Patients are older, sicker with higher expectations

8. Intensive Care Medicine Help: Colleagues Nurses ITU guidelines Computer

9. Intensive Care Medicine The ICM team: Consultants (11) Trainees (21) Parent specialty doctors Microbiologists, pathologists Nursing staff Technicians Secretaries Physiotherapists Pharmacists Dieticians Receptionists Cleaners

10. Intensive Care Medicine

11. Swansea 28 ITU beds in Morriston Hospital No. of admissions: over 1100 per year –42% surgical, 58% medical Tertiary centre – trauma / vascular / pancreatic disease / renal Other critical care areas: Burns unit Cardiac ITU

12. Intensive Care Medicine

13. Induction Meeting, Appraisal meetings 2 ACCS trainees on 1 st on call rota Allocated to one section of the unit during morning hand-over 2 consultant-led ward rounds Member of trauma and arrest team Ward referrals

14. Intensive Care Medicine Microbiology ward rounds Weekly audit / case presentations and journal clubs Weekly team based long stay patient reviews X ray teaching Bed side teaching

15. Intensive Care Medicine Ward round System-based presentation: CVS Respiratory Neurological Renal GI tract Haematological/ Infections Problems Management plan

16. Intensive Care Medicine Duties: Interventions Referrals Relatives Discharge summaries Death Certificates

17. Intensive Care Medicine ACCS paperwork 6 DOPS 3 Mini Cex 4 CBD 1 MSF FICM documentation Educational Supervisor Report

18. Intensive Care Medicine Single/Dual CCTs: Entry routes: Anaesthetics, CMT, EM ACCS Primary exam Primary FICM exam not running yet (2014?)

19. Intensive Care Medicine Single CCT: Competitive entry at ST3 level Primary exam in entry specialty Annual interviews in ICM National interview process Soon: applications for ACCS ICM possible

20. Intensive Care Medicine Stage 1 ICM training: Appointments into ST3 and ST4 ICM training At the end of ST4 every trainee will have had: 1 year Anaesthetics 1 year ICM 1 year AM

21. Intensive Care Medicine Stage 2 ICM training: ST 5 year with specialty experience (cardiac, neuro, paeds plus other) ST 6 special interest Compulsory FICM exam: ST 5/ ST6 level

22. Intensive Care Medicine Stage 3 ICM training: 1 year of advanced ICM training

23. Intensive Care Medicine Dual CCTs: CT of 2 nd specialty 2 Applications (within 18 months) Additional 18 months of training needed Overlap of competencies

24. Intensive Care Medicine Why dual CCT? Broadens working opportunities Increasing demand for ICM consultants Anaesthetics: peri-operative physician AM/EM: close links

25. Thank you!

26. Questions?