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HigherSpecialistTraining

inIntensiveCareMedicine

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TableofContents

Introduction………………………………………………………………..…………………………….3

EntryRequirements…………………………………………………………………………………..4

ApplicationProcess……………………………………………………………………………………4

TrainingPathways……………………………………………………………………………………..5

Curriculum………………………………………………………………..…….……………………...15

Assessment……………………………………………………………………………………………..16

Examination…………………………………………………………………………………..……….22

Research……………………………………………………………………………………..…….......29

TrainingProgressReport……………………………………………………………….……….30

eLogbook…………………………………………………………………………..…………...………47

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IntroductionIntensiveCareMedicine(ICM)trainingisstructuredinIrelandasa‘supra-specialty’,competencybased,trainingprogramme.Supra-specialtytrainingcomprisestrainingwhich isundertaken inaddition to theachievementof full accredited training inapost-graduate medical ‘base-specialty’. Currently, these base specialties areAnaesthesia, Internal and Emergency Medicine and Surgery. As a supra-specialtyprogramme,knowledge,skillandcompetencyfromthebasespecialtyofthetraineeis enhanced and focussedwith 2 years supra-specialty intensive care training. Theoveralltrainingprogrammeisthatofahigherspecialisttrainingprogramme.Atthesuccessfulcompletionofhigherspecialisttraining in ICM,adoctorwillhaveacquiredtheadditionalknowledgeandcompetenciestoallowconsultantpracticeinICM–inadditiontothecompetencies(alreadyattained)inhis/herbase-specialty.Such a doctor will have achieved a standardised set of ICM competencies,compatiblewithEuropeanBoardofIntensiveCareMedicine-approvedCompetencyBasedTrainingProgrammeinIntensiveCareMedicineforEurope(CoBaTrICE)MissionStatementofJFICMI“To promote excellence in the practice of Intensive care medicine throughacontinuumof education, training, accreditation of specialists and research tomeettheneedsofthecriticallyillpatientsinIreland.”

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EntryRequirementsAspertheintroduction,specialtytraininginintensivecaremedicinecomprisesbasespecialties(Anaesthesia,InternalandEmergencyMedicineandSurgery)and2yearssupra-specialtyintensivecaretraining.Base specialty training is commonly 6 years.One year of intensive care training isallowedwithinthebasespecialtyprogramme,eitherasayearout-of-programmeoraspecialinterestyear.AsecondyearisundertakenpostbasespecialtyCSCST.Hencethe total duration of training is between 6 and 7 years for many trainees. ThecorrespondingpathwaystoICMtrainingareoutlinedbelowinaccordancewiththeparticular specialty background of the prospective Intensive Care Medicine post-graduatetraineedoctor.ApplicationProcessTrainees are appointed to supervised training posts through a central applicationsprocess under the auspices of the JFICMI. Currently there is an annual intake oftrainees,withvariabletrainingnumberscontingentonthenumbersofapplicantsforspecialinterestyearpostsandthoseeligibleforpost-CSTappointment.Thenumbersofeachisapproximately8atspecialinterestyearand4atpostCSCSTyearin2017.Applicationprocess is advertised inOctober, interviews inNovember /December,andappointmentsgenerallycommenceinJulyofthefollowingyear.All training posts are in intensive care units accredited via the JFICMI visitationprocess(seewebsiteforaccreditedhospitallist,www.jficmi.ie).

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TrainingPathwaysa)CurrentTrainingpathwaysandregulationsYear 1 of specialty ICM training is characterised by the acquisition of thecompetencies specified within the curriculum, technical and procedural expertise(seeLogbook/Procedures)andsuccessatasummativeFellowshipexam(Written,ClinicalplusViva)whichisundertaken(FJFICMI)attheendofyear1.IntensiveCaretrainingatYear1maybeachievedasaspecialinterestyear(SIY)inICM,aspertheestablished CAI training programme. Completion of Year 1 shall be in the senioryears of advanced training for all base specialties (ie. SAT 5/6 for anaesthesiatraineesandequivalentforotherbasespecialties).Wherethisyearofintensivecaretraining isnotcompletedwithin theanaesthesiaorother trainingprogramme, thetraineewillneedtocomplete2yearsofICMtrainingpostbasespecialtyCSCST.Duringyear2ofspecialtytraining,thereisnofurtherexaminICMbutpublications/project or other accreditation (for example in critical care echocardiography) isrequired - as is suitable to a pre-consultant year of training. Competencies to beattainedareasoutlinedintheJFICMICurriculumdocument,withaparticularfocusonprofessionalism,andclinicalleadership.Bytheendoftraining,year2traineeswillhavecompleted24monthsofdedicatedICMtrainingtoinclude:-Completionofallthe12domainsofICMcompetency-BasicCriticalCareechocardiographycompetence-AttendanceataBASICcourse-AttendanceatanIDAP(DonorAwarenessProgramme)course-Completionofaprospectivelyapprovedauditorresearchprojectwithassociatedpresentationsandpublication(s)-Specificadvancedtrainingincriticalcareechocardiographyorextra-corporeallifesupport (ECLS) training and accreditation or an alternative pathway to research(duration of trainingwould preclude satisfactory completion of both research andspecificadvancedtrainingmodules).b)CurrentTrainingOutcomesandCareerStructure:The successful completion of one year of ICM training (as above), which includessuccess at the FJFICMI exam, allows eligibility (in Ireland) for a ‘consultantwith aspecial interest in ICM’ position provided also that CSCST in base specialty isachieved.Thiscareeroptionisonlyutilised/availableinAnaesthesiaatpresent.

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The successful completionof a pre-approved second ‘supra-specialist’ year of ICMtraining(seeguidanceabove)willallowaccreditationasacompletedtraineeinICM.Such statuswill allow eligibility for specialist registration in ICMwith theMedicalCouncilofIrelandandeligibilitytoapplyforaConsultantinIntensiveCareMedicineposition.

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OverviewofTrainingPathways

I. ICMTraineeswithAnaesthesiaasbase-specialty:

AJFICMI-accreditedICUandHospitaltrainingpositionwillprovidethetraineewithexposure to a broad range of medical disciplines within a suitable teachingenvironmentwhileundergoingICMtraining.Theirprogrammeofcontinuingmedicaleducationmust includeawide rangeofgeneralmedicine topicsandaccess to theMedicinespecialtyPCS/CMEprogrammeasappliestoInternalMedicinetraininginthe Hospital. Specific access to certain skills and training opportunities (e.g.

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bronchoscopy,echocardiography,laboratorymicrobiology)mayalsobeincorporatedasrelevant.DurationofTraining:Thedurationoftrainingforananaesthesiatraineewhowishestocompletespecialtyaccreditation in intensive care medicine shall be 7 years for those who followpathway (A) in the above organogram. For those who follow pathway (B) in theaboveorganogramthedurationoftrainingshallbe8years.

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II. ICMTraineeswithInternalMedicineasbase-specialty:

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InternalMedicinetrainees:AnaccreditedcentreforICMtrainingmustincludeonedayperweek(orequivalent)of dedicated anaesthesia training. The trainee, over the course of year 1 of ICMtrainingmustachieve100intubations(2perweekapprox).Ofthese100intubations,at least 20 must be undertaken in emergency circumstances (emergencyanaesthesia,emergencydepartment,cardio-pulmonaryresuscitation,intensivecarepatients).CompetencewithgeneralairwaymanagementisrequiredandattendanceataDifficultAirwaycourseismandatory.DurationofTraining/InternalMedicine:The duration of training for an internalmedicine traineewhowishes to completespecialtyaccreditationinintensivecaremedicineshallbegovernedbythedurationoftrainingofthechoiceofHigherSpecialtyTrainingschemewiththeRCPI,withtheaddedsupra-specialtyintensivecaremedicinetrainingduration.ThereissomevariabilityinHSTdurations.Example1.RespiratoryMedicine:Thisisa5yearHSTprogrammewithinwhichisallowedoneout-of-programmeyear.Thisout-of-programmeyearhasbeenallowedtodatetobeayearinintensivecaremedicine.Henceviapathway(A)intheaboveorganogram,thetraineewouldhaveadurationof trainingof2 years atBST, 5 yearsHST includingoneyear ICM, thenafinalyearofICM,givingatotalof8yearstraining.Forthosewhofollowpathway(B)intheaboveorganogramthedurationoftrainingshallbe9years.Example2.InfectiousDiseases:EightornineyearssameasaboveExample3.MedicalOncology:Thisisa4yearprogrammewithinwhichisallowedoneout-of-programmeyear.Pathway(A)thereforeis7years.Pathway(B)thereforeis8years.

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iii. ICMTraineeswithSurgeryorEmergencyMedicineasbase-specialty:

AnaccreditedcentreforICMtrainingmustincludeonedayperweek(orequivalent)of dedicated anaesthesia training. The trainee, over the course of year 1 of ICMtrainingmustachieve100intubations(2perweekapprox).Ofthese100intubations,at least 20 must be undertaken in emergency circumstances (emergencyanaesthesia,emergencydepartment,cardio-pulmonaryresuscitation,intensivecare

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patients).CompetencewithgeneralairwaymanagementisrequiredandattendanceataDifficultAirwaycourseismandatory.AJFICMIaccreditedICUandHospitaltrainingpositionwillprovidethetraineewithexposure to a broad range of medical disciplines within a suitable teachingenvironment while undergoing ICM training. Their programme of continuingmedicaleducationmustincludeawiderangeofgeneralmedicinetopicsandaccessto theMedicine specialty PCS / CME programme as applies to Internal Medicinetraining in the Hospital. Specific access to certain skills and training opportunities(e.g. bronchoscopy, echocardiography, laboratory microbiology) may also beincorporatedasrelevant.DurationofTraining/Surgery:TheNationalSurgicalTrainingProgrammeisan8yearprogramme.* The RCSI Specialty Training Scheme currently is unable to provide a year out ofprogrammeorspecialinterestyearinintensivecaremedicine,andhenceforsurgicaltraineeswishingtofollowacareerinintensivecaremedicinethecurrentpathwayis(B),andtherefore10yearsduration.EmergencyMedicinetrainees:Core specialist training in Emergency Medicine (CSTEM) includes a mandatorymoduleof6monthsAnaesthesia/IntensiveCareMedicine.ForthoseprogressingtointensivecaretrainingrecognisedbytheJFICMI,thetrainee,overthecourseofyear1of ICMtrainingmustachieve100 intubations (2perweekapprox).Of these100intubations,atleast20mustbeundertakeninemergencycircumstances(emergencyanaesthesia,emergencydepartment,cardio-pulmonaryresuscitation,intensivecarepatients).CompetencewithgeneralairwaymanagementisrequiredandattendanceataDifficultAirwaycourseismandatory.DurationofTraining/EmergencyMedicine:The National Emergency Medicine Training Programme is a 7 year programme.Approval for Pathway (A) above would therefore allow the trainee to completetraininginan8yearperiod.Year3ofCoreSpecialistTraininginEmergencyMedicinecurrently has a structure 6 month period of Anaesthesia and/or Critical CareMedicine.Onan individual basis todate a longerperiodof intensive care traininghas been recognized. This provision requires on-going engagement with the IrishCommitteeforEmergencyMedicineTraining.Pathway(B)wouldallowadurationoftrainingovera9yearperiod.

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iv. ICMMonospecialtyTraining:ThereisnoapprovedprogrammeformonospecialtytraininginintensivecaremedicineinIreland.

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Summary of Training Duration per Base Specialty

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CurriculumCoBaTrICEisaninternationalpartnershipoftrainingorganisationsundertheaegisoftheEuropeanSocietyofIntensiveCareMedicine.Theprogrammehasdevelopedaninternationally acceptable competency-based training programme by usingconsensus techniques (Delphi and Nominal Group) to develop minimum corecompetenciesforspecialistsinintensivecaremedicine.The competencies have been developed as the roles and skills of the intensivistdevelop and change over the years and are informed by advances in medicaleducation. The CoBaTrICE curriculum is endorsed by the European Board ofIntensive Care Medicine and the national training organisations of 28 Europeancountries.Anumberof countrieshave adopted theCoBaTrICE curriculumdirectly,eg.Netherlands. In others, egUK Faculty of IntensiveCareMedicine, the relevantcompetencieshavebeenmappedtotheCoBaTRICEcompetencies.The JFICMIhasadopted theCoBaTrICEcurriculum, thoughsimilar to theFICMUK,has articulated the syllabus in such a manner to map the competencies toassessmentmethodologyandtotheMedicalCouncilDomainsofGoodProfessionalPracticeThefullcurriculumfortheJFICMIisavailableontheJFICMIwebsite-www.jficmi.ie Thecompetencybased trainingstructure isdesignedtomakeavailable to traineestherequiredpracticalskills,clinicalexperience,andtheoreticalknowledgethroughclinicallybasededucationprogrammesandexampreparation.The curriculum outlines the elements of knowledge, skills, and competenciesmappedtotheMedicalCouncil8domainsofGoodProfessionalPractice.

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AssessmentProgression through training is predicated on satisfactory participation andperformanceinthefollowingassessments:

o Consultantfeedbackatinterim(“in-term”)trainingassessment.Thisisa structured meeting between the trainee and their trainingsupervisortodiscussthetrainee’sperformancetodateaswellastoupdate the trainee’s learning goals for the remainder of their ICMmodule. Feedback delivered to the trainee is derived fromobservationoftheirdailyperformancebythetrainingsupervisorandby other consultants within the clinical department. This processseeksfeedbackfromthetraineeandissignedoffbybothparties.

o Workplace-basedassessments:§ Direct observation of procedural skills (DOPS): a real-time

observation of a trainee-patient interactionwhich involves aclinical procedure. This is followed by structured feedbackfromanICMconsultantobserver.

§ Mini-clinical examination exercise (Mini-CEX): a real-timeobservation of a trainee-patient clinical interaction followedbystructuredfeedbackfromanICMconsultantobserver.

§ Case-based discussion (CbD): a retrospective discussion

between the trainee and an ICM consultant about a clinicalcase managed by the trainee in the course of their dailypractice.

§ Entrustable professional activities (EPAs): discrete tasks or

competencies of high importance in intensive caremedicine.Traineesareratedfrom1-5(increasingorderofcompetence)basedontheirperformanceasassessedbyDOPS,Mini-CEXorCbD.

o Review of eLogbook at www.jficmi.ie website. This enables thetrainingsupervisortoviewatrainee’srecordofclinicaltimespentintheICU,thecasemixofpatientsmanagedduringthistimeaswellastheproceduralskillsundertakenduringthemodule.

o Consultant feedback on involvement in departmental audit and

journalclubactivities

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o Clinical microbiology / infectious disease multidisciplinary ward

rounds – all trainees participate and present cases at these rounds.TheseareamandatorypartoftheJFICMIhospitalaccreditationasatraining site and part of the assessment of knowledge as per theCurriculum

o ICU/Radiologymultidisciplinary rounds – all trainees participate andpresent cases at these rounds. These are a mandatory part of theJFICMI hospital accreditation as a training site and part of theassessmentofknowledgeaspertheCurriculum

o Traineeclinicalandeducationalpresentationsandfeedback.

o Trainee participation in ICU Multidisciplinary rounds withphysiotherapy,occupationaltherapy,nutritionalandspeechtherapyservices.

MandatoryCourses:

AnumberofcoursesaredeemedmandatorybytheJFICMI,allofwhichincludeacompletionassessment:

o IntensiveCare SimulationCourse: amandatory course that assesses

clinical reasoning as well as non-technical skills such as taskmanagement, team working, situation awareness and decisionmaking

o Difficultairwayworkshop(CollegeofAnaesthetists).

o ACLS

o Basic Critical Care Echocardiography training (JFICMI) and logbook:basic transthoracic echocardiography is now an essential skill forthose practicing in the field of intensive care medicine and is amandatorycoursefortraineecompletingyear2ofICMtraining.

o Irish Donor Awareness Programme course (JFICMI): a mandatorycoursefortheprofessionalismandskillsrelatedtoorgandonation

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DesirableCourses

AnumberofcoursesarerecommendedasdesirablebytheJFICMI,allofwhich include a completion assessment. Some of these courses aredeliveredbytheJFICMI,othersaslistedbelow.

o BASICcourse(IntensiveCareSocietyofIreland)o CriticalCareRefreshercourse(JFICMI)o ATLSo BeyondBASIC:MechanicalVentilationcourse(IntensiveCareSociety

ofIreland)o BeyondBASIC:Nephrologycourse(IntensiveCareSocietyofIreland)o JFICMIExaminationshortcourse(JFICMI)o APLS/PALSorequivalento Transport Medicine course (HSE National Transport Medicine

Programme)o National Patient Safety Conference attendance (College of

AnaesthetistsofIreland)o Quality Improvement Changing Healthcare for the Better course

(RCPI)

SummativeassessmenttoolsforICMtrainingareasfollows:

o Consultantfeedbackatfinal(“end-of-term”)trainingassessment.Thisis a structured meeting between the trainee and their trainingsupervisorandat leastoneotherconsultantcolleagueat theendofan ICM module. The purpose of this assessment is to review atrainee’s performance and thereby decide to either (a) recommendtrainee progression to the next stage of their training or (b) tohighlight any concerns about the trainee’s performance that mightdelay progression to the next stage of their training. The latterinformation is transmitted to the JFICMI Training Committee via anonlinelinkonthewww.jficmi.iewebsite.Thisprocessseeksfeedbackfromthetraineeandissignedoffbybothparties.

o JFICMIFellowshipexamination:§ Shortanswerquestions:8SAQsinwrittenformat§ Multiple choicequestions: 100questionswith a combination

of single-best-answer questions (type A) and complexmultiple-answerquestions(typeK)

§ Bedsideclinicalexamination:onehourprocesscomprisingonelongcaseandtwoshortcaseclinicalassessments

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§ Datainterpretation:acombinationoflaboratoryandradiologyintensivecaretestspresentedinanelectronicformat

§ Vivaexamination:cross-tablediscussionaboutacombinationofclinical,non-clinical,administrative,professionalandethicaltopicsrelevanttointensivecaremedicine

o ReviewofeLogbookonwww.jficmi.iewebsiteo ConfirmationofattendanceatmandatoryJFICMIeducationalcourseso Confirmation of satisfactory participation in ICM educational and

researchactivitiesduringtrainingmoduleso Evidenceofcompletionofadvancedtrainingcourse(eg.Transthoracic

echocardiography)

Final “sign-off” process: A final interview between the trainee and members ofJFICMI Training Committee to ensure that all training requirements have beensatisfied. This is followed by a recommendationmade to the JFICMI Board aboutwhetherthetraineehasachievedsatisfactorycompletionofICMtrainingornot.The table below summarises the key components of training in intensive caremedicine and the assessmentmethodsused to ensure that a traineehas satisfiedthese components of training. They represent an abbreviated version of the 12domainsoftrainingandassessmentcontainedintheJFICMICurriculum.

Key training component

Formative assessment method(s)

Summative assessment method(s)

Knowledge of critical illness

• Consultant feedback in the workplace • Interim “in-term” assessment with SOT • CbDs, Mini-CEX • Participation in clinical and educational presentations • Courses – mandatory and desirable

• JFICMI examination – MCQs, SAQs and Vivas • eLogbook showing case mix of patients managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members • Attendance at mandatory courses

Diagnostic evaluation and investigation of patient with critical illness

• Consultant feedback in the workplace • Interim “in-term” assessment with SOT • CbDs, Mini-CEX, DOPS, EPAs • Participation in ICU clinical rounds (radiology, microbiology rounds) • Courses – mandatory and

• JFICMI examination – MCQs, SAQs, data interpretation, bedside examination, Vivas • eLogbook showing case mix of patients managed • “End-of-term” assessment with SOT • “Sign-off” interview

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desirable

with Trainee Committee members

Procedural skills • Consultant feedback in the workplace • Interim “in-term” assessment with SOT • eLogbook showing procedures performed in clinical practice • DOPS, EPAs • Courses – mandatory and desirable

• eLogbook showing case mix of patients managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members • Attendance at mandatory courses

Critical disease management (including peri-operative care)

• Consultant feedback in the workplace • Interim “in-term” assessment with SOT • CbDs, Mini-CEX, DOPS, EPAs • Participation in clinical and educational presentations • Courses – mandatory and desirable

• JFICMI examination – MCQs, SAQs, Vivas • eLogbook showing case mix of patients managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members

Managing patient comfort and recovery

• Consultant feedback in the workplace • Interim “in-term” assessment with SOT • CbDs, Mini-CEX, DOPS, EPAs • Participation in ICU multidisciplinary meetings (physio, OT etc)

• JFICMI examination – bedside examination, Vivas • eLogbook showing case mix of patients managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members

End of life care • Consultant feedback in the workplace • Interim “in-term” assessment with SOT • CbDs, Mini-CEX

• JFICMI examination – Vivas • eLogbook showing case mix of patients managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members • Attendance at mandatory donor awareness course

Transport of the critically ill patient

• Consultant feedback in the workplace • Interim “in-term” assessment with SOT • DOPS • eLogbook review of intra- and inter-hospital transfers

• JFICMI examination – Vivas • eLogbook showing patient transfers managed • “End-of-term” assessment with SOT

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• Transport medicine course – desirable

• “Sign-off” interview with Trainee Committee members

Patient safety and healthcare management

• Consultant feedback in the workplace • Interim “in-term” assessment with SOT • eLogbook review • Consultant feedback on management and leadership skills • Involvement in organizational, administrative and committee activities in hospital and ICU • Consultant feedback on involvement in departmental audit and journal club • Courses - desirable

• JFICMI examination – SAQs, Vivas • eLogbook showing patient transfers managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members

Professionalism • Consultant feedback in the workplace • Interim “in-term” assessment with SOT • CbDs, EPAs • eLogbook review • Consultant feedback on ICU educational, research and audit activities

• JFICMI examination – SAQs, Vivas • eLogbook showing patient transfers managed • “End-of-term” assessment with SOT • “Sign-off” interview with Trainee Committee members

Table legend: Assessment tools mapped to components of training. For more details about courses, see section 5.1.1 or appended Curriculum document. [SOT: Supervisor of Training, MCQs: multiple choice questions, SAQs: short answer questions, DOPS: direct observation of procedural skills, CbDs: case based discussions, Mini-CEX: mini clinical examination exercises, EPAs: entrustable professional activities]

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Examination1. GeneralTheFellowshipexam(FJFICMI)isasummativeexaminationprocesswithintheglobaltrainingofapostgraduatedoctorinIntensiveCareMedicine(ICM)andisfundamentaltotheroleoftheJointFacultyofIntensiveCareMedicineofIreland(JFICMI) in the overall supervision of Training in ICM in Ireland. Theresponsibility of the JFICMI to conduct a Fellowship exam is entrusted to itsExaminationandTrainingCommitteesandtheirChairs.The examhas2parts: part1 (written:MCQandSAQ) andpart2 (clinical andvivaexams).2. SettingtheExamThe exam is set by the Examination Committee threemonths in advance of itbeingheld:thewrittenexambeingnormallyconductedinApril-May.Examofsixsections Section Content TimeallowedPart1 -MCQ 1 TypeAandK

Questions60mins

-SAQ 2 8shortanswer(SAQ)

90mins

Part2 -Clinic1 3 MajorCasex1 30mins-Clinic2 4 MinorCasesx2 30mins-Viva1 5 ECGs,Radiology,

Labs,Traces20mins

-Viva2 6 IntensiveCareTopics

20mins

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Having 6 distinct sections ensures the candidate is examined by differingexaminationtechniquesandexposeseachcandidatetomanyexaminersmakingitabalancedandfairprocess.Thepart1examconsistsof100multiplechoicequestionsand8shortanswerquestions. The MCQ are divided into 20 single best answer and 80 multiplechoicequestionseachcarrying1markandthetimeallowedis60minutes.TheMCQsarederivedfromanextensivebankhousedattheJFICMIsecretariatandisrenewed annually by practising intensivists. With each new sitting some oldquestionsandsomenewquestionsareusedthusstandardisingthedifficultytoprevious years. MCQs are set by JFICMI examiners and then vetted by theexamination committee for content, quality and accuracy. The MCQ paper ismapped to the syllabus of the training program ensuring the candidate isexaminedacrossallaspectsofintensivecaremedicine.BoththeMCQandwritten(SAQ)paperseekstosetabalanceofmedical,surgicaland general critical care questions which are mapped to the syllabus of thetraining program ensuring the candidate is examined across all aspects ofintensivecaremedicine.3. DatesandvenuesExam:Oncethedateforthewrittenexam(part1)isset,thehospital(s)whichwillhosttheclinicalexam(part2)is(are)agreed,usuallyonarotationalsystem.TheClinical/VivaexamisconductedoveronedayandisusuallyinMay.Course:Thepre-examcourseisrunbytheJFICMIoverthreedaysintheMarchbeforetheexam.PositionsarelimitedandpreferenceisgiventoregisteredICMtrainees who are eligible to take the JFICMI fellowship exam. The course isnormallyconductedinthreeDublinhospitals.Closingdateforapplications: This is set to allow time for administrativeorganisation and for review of applications by the Chair of the Examinationcommitteetoensurecompliancewithexameligibility.4. CandidatesSeeTrainingPathwayforindividualspecialtybackgrounds.Applicants are also required to have attained at least one year of approvedtraining in ICM, up to 6 months of which may have been in ‘complementarydisciplinetraining’.CandidatesarerequiredtobecomeregisteredtraineeswiththeJFICMIandtohavetheirtrainingprospectivelyapproved.

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5.ArbitrationonCandidateperformanceintheExama)StandardoftheExaminationThe standard required in the JFICMI Fellowship examination is that of aconsultantspecialistorseniortraineewhohassatisfactorilycompletedat leastoneyearofspecific,supervisedIntensiveCareMedicinetraining.Thecandidateshouldshowevidenceofskills,attitudesandknowledgethatshouldallowhim/hertotakechargeofanICU(andthemanagementofitspatients)foraperiod.The candidatewill be expected to show consistent evidence of competence topractiseindependentlyinintensivecaremedicine.Thiswillincludeevidenceofacapacitytoconsultotherservicesappropriatelyandingeneraltomaximisethemultidisciplinaryenvironmentofcriticalcareforoptimumpatientbenefit.b)MarkingsystemWith reference to the six-section format of the exam (see below and also theJFICMI’sExamFormatdocument),eachofthesixsectionsismarkedwithequalimportance i.e.amaximumof5marks(range0–5)persection. HowevertheFellowship exam is a clinical exam primarily and a premium is attached topassing the clinical sections of the exam. A pass mark (6), between the twoclinicalcomponentsoftheexam,isarequirementtopasstheexam.c.Assessmentonwhichmarkingisbased:Asixpoint‘closed’markingsystemisused,themarksbeing:

BadFail/Veto 0Fail 1BareFail 2Pass 3GoodPass 4Excellent 5

Themarkingsystemisdesignedasaclosedmarkingsystem.

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Eachsectionoftheexam(apartfromtheMCQ)isscoredbyapairofexaminers.i.e.: AllwrittenSAQpapersareexchangedbetweenapairofexaminers 2examinersforeachclinic 2examinersforeachvivaThe scores awarded to each candidate at all interactive sections of the exammustbeagreedandrecordedbytheexaminerpairattheendofeachsectionoftheexam–beforebeginningtoexamineanothercandidate.Itisanticipatedthatthe Externwill examinewith different pairs of examiners throughout the day,andmayactattimesasanobserver,athis/herdiscretion.d.ApplicationofthemarkingsystemtovarioussectionsoftheExam

1. MCQSection: TheMCQismarkedas

1mark =correctanswer 0mark =incorrectanswerornoanswer i.e.thereisnonegativemarkingintheMCQ

2. Paper(SAQs)section: TheSAQpaperissat1houraftertheMCQhasbeencompleted.Thecandidateshave 90 minutes for this paper. The model answers are vetted by theexaminationcommitteeforcontent,qualityandaccuracy.There are usually four paper-marking examiners, who are divided into twomarkingpairs.Each question is to be marked in accordance with JFICMI standard markingsystem(0–5).Examiners are requested to use the 0 (zero: i.e. veto) mark only in extremecircumstances. Ifitisused,theexaminerswillbeaskedtojustifytheirmarkateitherthescriptrevieworcall-overmeetings.

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At the end of the SAQmarking process, the totalmarks for the SAQs for eachcandidatearecollatedbytheChairmanoftheExamination,thecompositemarksbeingaddressedasfollows.Intheeventofthecompositescorebeingotherthana whole number (e.g. 2.4), the mark (for this section of the exam) will beroundedtothenearestwholenumber e.g.<2.5shallberoundedto2 ³2.5shallberoundedto3AdmissiontoPart2(Clinical/VivaExam): Themarks from section1 and2 of the examare added for each candidate. Amark of ³ 5 is required in these two sections to qualify for admission to theclinical/vivasectionsof theexam.Onreceiptofhis/her results thecandidatecanapplytopresenttopart2oftheexam.Ifacandidatescoresamarkof³5(i.e.pass),he/shemaydeferpresentingtopart2foroneyearonly.Ifhe/shedoesnotapply for and present at the subsequent part 2 exam, then he/she forfeits theoriginalresultsofpart1andmustrepresentforpart1.Part2ofexam–Clinicsx2andVivasx2Part2consistsof4parts:2clinicalsectionsand2cross-tablevivasections.Theclinicalsectionsconsistofonemajorcasewhichcarriesamaximumof5marksand2minorcaseswhichtogethercarryamaximumof5marks.Eachvivacarriesa maximum of 5 marks. Part 2 in total carries 20 marks. The candidate isexaminedineachsectionofpart2byaminimumof2andoften3examiners.Thecandidate is examined by different examiners in each section of part 2. Theclinicalcases(bothmajorandminor)haveaPerformasetofclinicalfindingsthattheexaminersaregivenprior toexaminingeach candidate, thus standardisingthe exam. The viva sections have pre-written model answers that have beenscrutinisedbytheexaminationcommittee,thusstandardisingthissectionoftheexam.

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OverallExamMarking–courtofexaminers’‘call-over’.Once the marks from the Clinical / Viva section of the exam are collated,attention is given to the overall results from the exam. The ‘call over’ is theforum of the examiners where all the marks are collated and the finaladjudication is agreed by all present – in accordance with the ‘marking’regulationsoutlined.Vetomarks (0)will be the subject ofdiscussionand issuesof counsellingmayneedtobeaddressed.OverallexaminationresultPass 18marksProvided

a) The combined mark achieved in clinical sections (3 and 4) is 6 orgreater

b) Thecandidatehasnomarkof0(veto)inanysectionoftheexamFacultyMedal Thecandidatewhoachievesfirstplaceintheexamprovidedthemarkawardedis³25marks

Although theoverallpassmark is18(withprovisions - seebelow), candidateswhosecompositemarkis17shallbereviewed,providedthecompositescorefortheclinicalsections(majorandminorcases)is³6.If the highest marked candidate has achieved a mark of 25 or over, (s)he isconsidered for the award of the JFICMImedal and a recommendation for theawarding of the Medal should go to the next Board meeting. The medal isnormallyawardedatthetimeoftheconferraloftheFellowship.AnnouncementofResultstoCandidatesThe results are announced immediately after the call-over and the successfulcandidatesareinvitedtomeettheexaminers.The candidateswhowere not successful are offered the opportunity for examfeedbackontheirexamperformanceandforadvice/counselling.

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Research CompletionofanauditorresearchprojectisarequirementofthetwoyearsofICMspecialist training. Trainees are encouraged to acquire research training andcompetence and the achievement of a successful (preferably published) researchworkduring training is recognised forcreditandaccolades towardscertificationofcompletion of specialist training. Those who have pursued a research pathway intheir base specialty training will also be encouraged to continue their academicresearch. Thepost-CSCSTyear(Year2ICMTraining)isstronglyclinicalinfocus.Anon-clinicalday is built into the working week, thereby affording approximately 20% of timetowardsresearchoraudit.Asubmissionforadedicatedperiodoftrainingdevotedto researchwillbeconsideredby theTrainingCommitteeona casebycasebasis,informedbythepriorresearchopportunitiesandresearchproductofthecandidateaswellascumulativeintensivecareandcomplimentarytrainingtodate.

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TrainingProgressReportTheSupervisorofTraining is requiredtoreviewwitheachtraineetheirknowledgeand training experience. All trainees are required to acquire proficiency in the 12competenciespresentedhere.Thetrainee’sexperienceisalsosupportedbytheireLogbook.Thisisanopportunityto review the eLogbook which gives a broad overview of case-mix, complexity,proceduralexperience,andprofessionalism.Thesecompetenciesdonothavetobecompletedallatonce,butcanbeaddressed,savedandupdatedatintervalsduringthetrainee’stimewithyou.Pleasenotethereisanoption ineachcompetencytoaddfreetext forbothtrainerandtrainee,andeachassessmentshouldbediscussedwiththetrainee.If a trainee has further ICM modules to complete at another centre, their newSupervisorofTrainingwillalsoberequiredtoreviewanewfullsetofcompetencies.Hence,thetraineeshallaccruemorecompetencieswitheachmodule.However,thetrainee needs to be advised where deficiencies exist to allow the opportunity tocorrectthese.Wewouldthereforealsoencouragefrequentmeetingswithtraineessothatanyproblemsareidentifiedbybothsidesinatimelymanner.Please note, the last option on each competence page is a statement of concernregardingatrainee’ssuitabilityforintensivecaremedicine.Ifthisoptionischosen,theconcernissubmittedtotheJFICMITrainingCommitteeforfurtherconsideration.The Training Progress Report overview in the following pages is available on-linethroughtheJFICMIwebsiteusingaSupervisorofTraininglogin.

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eLogbookEverytraineeisrequiredtomaintainaneLogbook.ThisisaccessibletoeveryregisteredtraineewiththeJFICMIusingtheirsecurelogindetail.TheeLogbookisusedassupportingevidenceofexposuretoawiderangeofintensivecareexposure,case-mix,professionalinteractions,andproceduralactivites.TheHelpsectionandFAQhelpsguidetheUserintheuseofthislogbook.Theoptiontocreateareportisdescribedandthisallowsthetrainee,andJFICMI,redevelopandretaintheelogbookportfolio.PleasebeawaretheelogbookisrequiredforreviewofcompetenciesandtrainingprogresswithboththeSupervisorofTrainingandtheJFICMITrainingCommittee.TheeLogbookoverviewofcontentinthefollowingpagesisavailableon-linethroughtheJFICMIwebsiteusingyourUserlogin.

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