Critical Care Medicine is the specialty looking after patients who are critically ill. The consultants and trainees work mainly in the Intensive Care Unit, but will be involved with the care of critically ill patients anywhere in the hospital. The majority of consultants combine the specialty with Anaesthesia. It is increasingly common to see consultants who combine Critical Care Medicine with another specialty such as Respiratory Medicine or work exclusively in critical care. Critical Care Medicine was one of the first specialties to establish a competency based training programme.
Advantages and Disadvantages of a career in Critical Care Medicine
- Exciting stimulating, and varied work
- Work closely with colleagues from many specialities
- Opportunity to lead multidisciplinary team
- Dynamic, rapidly changing patient base
- Opportunity to make a difference to patients and relatives
- Units generally well resourced with staff and equipment
- Brings physiology and pharmacology to life
- Good career progression
- Prolongs training time to becoming a consultant
- Antisocial working hours
- Work can be emotionally draining
- Limited opportunities for private practice
- Resources often stretched, forcing difficult decisions about priorities of care
- SpR in anaesthesia, general internal medicine or subspecialty, general surgery or subspecialty, accident & emergency medicine
- Satisfactory completion of SpR year 1 for Step I (intermediate level) training
- Normally be within 1 year of obtaining CCT in base specialty after completing Step II (advanced level) training.
- FRCA, MRCP, FRCS or European equivalent.
- Three months ICM at basic level (SpRs without this prior requirement may be offered this training outside the CCT programme)
Experience of emergency medical care; Advanced Life Support provider status; Evidence of interest in pursuing a career in ICM; Knowledge of critical care research.
Competency based training
Critical care medicine was one of the first specialities to establish a competency based training programme. The Intercollegiate Board oversees training in ICM for Training in Intensive Care Medicine (IBTICM). To enter higher specialist training as a SpR at least 3 months training at senior house officer level is required in an intensive care unit approved by the board. Competencies in the complimentary specialities of anaesthesia and acute medicine (6 months of each) must be acquired, ideally during additional SHO appointments. The higher specialist training programme requires the completion of 6 months ITU experience and the completion of 10 extended case summaries for step 1 training. To obtain a certificate of completion of training incorporating ICM (always awarded with a base speciality or specialities), a further 12 months of dedicated ICM training is required (step 2).
Good communication skills, caring and supportive of patients and their relatives. Able to work in and learn from a multidisciplinary critical care environment. Courteous, meticulous and hardworking. Good physical health; Ability and enthusiasm for medical research and an enquiring mind.
Dr. Z. P. Khan
Regional Advisor and STC Chair Critical Care Medicine
Specialist Training Opportunities
There are currently 8 SpR posts in the West Midlands
Day in the Life of ITU registrar
"My Route into the ICM advanced training program was through Respiratory Medicine. I applied for the ICM training as I had already done 6 months of ITU as an SHO (basic level trainee), and realised that this was the specialty for me. Although others have switched from Medicine to Anaesthetics to pursue this, I wanted to stay within medicine. After finishing my 2nd year as a Respiratory SpR I had 6 months of Anaesthetic SHO training and then moved on to ITU as a Registrar.
As an ICU Registrar I am expected to do my own ward rounds and supervise the SHO’s, but always with consultant support. The nature of ITU is that patients are often managed by different specialties, and a lot of time is spent in coordinating opinions and referrals so that the appropriate advice is obtained promptly. The main business of the ITU team is managing the patient’s respiratory, haemodynamic and metabolic physiology whilst the underlying problems are dealt with. In practice this means managing ventilators, invasive and non-invasive haemodynamic monitoring, the administration of inotropes and vasopressors, and renal replacement therapy, if it is required. Due to the relative sickness of ITU patients, patient management decisions often have to be made at consultant level, and this makes registrars less important perhaps in service provision, than in other specialties, but the attitude of the modern ICU is one of collegiality, and all opinions are listened to.
As well as all this I have a role in teaching of both ICU nurses and the junior doctors. As a trainee I have never been in a job where the opportunities for education are encouraged as much, or are as readily available. The learning curve is steep, but you are given a leg up."
Dr. C. Bassford
Specialist Registrar in Intensive Care Medicine and Respiratory Medicine
City Hospital, Birmingham
Consultant ITU days
"Although I spent my trainee days regarding ITU medicine with suspicion, I was drawn into it as a consultant.
I find the interesting part of ITU medicine to be about the human relationships with patient’s relatives, nurses, consultant and trainee colleagues, physiotherapists, pharmacists, and colleagues across the hospital. The better the relationships the easier the job tends to be.
I don’t enjoy not having the resources available to treat all comers to ITU, though we try hard to use our resources as efficiently as possible.
I don’t enjoy seeing young people dying, leaving parents, spouses and offspring behind, but paradoxically this is a part ITU medicine it is possible to do well and make a difference.
Lastly, the senior nurses and doctors in ITU must try to agree a team approach: nothing saps morale more than therapy which changes predictably according to who is in charge."
Dr. A. McKenzie
Consultant Intensive Care Medicine
City Hospital, Birmingham