Surviving PICM Grid

Welcome

Congratulations on gaining a Grid post in Paediatric Intensive Care Medicine (PICM). This has been written to help you get the most out of your PICM training and most importantly, tick all the boxes needed to get signed off at the end! We have written and edited this repeatedly and in good faith. The shape of training is ever changing, so if you feel there are errors or omissions, your feedback is welcome at picstraineerep@gmail.com

 

Key Contacts

  • PCCS Trainee Representatives at picstraineerep@gmail.com. Follow us on Twitter @PICStrainees
    • For advice about training matters, masterclasses, practical issues.
  • PICM ISAC Committee:-
  • Your local Buddy
    • We have set up a “Buddy Up” system that will hopefully put you in touch with a trainee one or two years ahead of you in your training centre. We hope they will be able to provide you a lot of practical advice about your jobs. (How the hospital works, who to go to for rotas etc.)
  • Educational Supervisor
    • You should be allocated one on arrival at your training centre. They should be able to give you clear advice, but from time to time, messages from the top may not have filtered through. If you are unsure, please contact one of the above.

 

 

Posts

There is a huge variety to the posts you will be doing. Some of you will remain in one unit for the duration, whilst others move a couple of times. The aim is that you get adequate exposure to a range of cases. For those of you doing posts in a stand-alone retrieval service, make sure it does not take up more than 6 months of your 2 years of Grid.

You can of course spend more time in any specific areas you want to specialise in, but make sure that does not reduce the time you spend in your core units. If you feel you are not receiving the training you need or expect please feed that back to us.

There is also the mandatory annual trainee survey that you are required to complete and submit on time. We cannot stress enough about reporting fully any issues you are having (however big or small). Training centres must provide the training you are required to receive.

All Paediatric trainees will also need to spend at least 6 months in anaesthetics. All units have organised links with an anaesthetic department in order to facilitate this. You need to do it as an OOPE and this means getting the paperwork signed off at least six months in advance. Please don’t get caught out by leaving it too late. Further information can be found here – http://www.rcpch.ac.uk/training-examinations-professional-development/postgraduate-training/resources-trainees-training-s-3

Masterclasses

These are study days that are organised by us, for us. PCCS members are subsidised and you will soon be able to register via the website.

We aim to hold up to 4 single day Masterclasses and a COMPULSORY 2 day Summer Masterclass. At this masterclass, grid trainees are expected to submit 2 abstracts; one of which will be presented and represents an externally assessed case based discussion and forms one of your extended case summaries for the year. You are expected to attend and present at this meeting even if you are on OOPE. The presentations are 10 minutes long with including time for questions from the panel or audience.

During the event, you will also have a face to face meeting with the PICMISAC members. This is to review your progress including your e-portfolio, work based assessments and documentation and evidence of your meetings with your educational supervisors (in the form of your Annual Trainers Report). If any issues have been raised on the mandatory trainee survey (which will be sent prior to the Masterclass), this can be further explored and discussed.

This meeting will feed into your ARCP (New GMC requirement).

 

Curriculum & Kaizen

The previous ICTPICM paper based competency document has re-appeared on the RCPCH website http://www.rcpch.ac.uk/system/files/protected/page/PICM%20Year%201%20Competency%20document%20(2).pdf and http://www.rcpch.ac.uk/system/files/protected/page/PICM%20Year%202%20Competency%20document.pdf. This is a useful guide for trainers and trainees to use during educational supervisor meetings and can guide the PICMISAC panel for your ARCP. It is NOT MANDATORY but some educational supervisors will be familiar with this, and the PICMISAC panel are happy to accept this.

The PICM Curriculum can be found on http://www.rcpch.ac.uk/training-examinations-professional-development/postgraduate-training/sub-specialty-training/paedia-6

It is also on Kaizen and formulates your Competencies. Please note that your Kaizen portfolio formulates evidence of your training, and it is generally useful to populate it with links, comments and uploaded documents. Please ensure there is a folder in your Documents section that is labeled CASES for your 10 Extended Case Summaries.

As Paediatric trainees, you will also be expected to populate the Level 3 competencies in General Paediatrics and Generic Competencies. Remember, your CCT will be in Paediatrics and PICM.

Don’t forget to document practical skills in the Skills Logs and ensure you verify these with a name and NMC/GMC number.

Ensure your Developmental Log is populated with all types of activity – log Masterclasses, departmental meetings, teaching sessions, presentations, conferences etc. Link these to the curriculum.

Your personal library should organised and contain copies of your APLS/NLS certificates and any other certificates. Whilst not compulsory, it may help your ARCP panel to upload your workplace base assessments into your personal library. Screenshots will suffice.

Your portfolio will be scrutinised at the Summer Masterclass and your Deanery ARCP.

The curriculum and E-portfolio is undergoing massive changes. The content of the curriculum will remain as is until around 2018, after which the entire format will change. There will be an overlap period whereby trainees can choose which version to complete. We will cross this bridge as information arises. There are 3 deaneries who will be piloting the new portfolio, and these will be announced in due course.

 Extended Case Summaries

These are a vital part of your training. Over your two years as a Grid trainee you will be expected to complete 5 case reports per year. 1 of these will be your case presentation at the summer masterclass.

The remaining 4 should be 1000 word reports based on a case you have seen. You should produce an evidence based summary of a specific aspect of the patient’s care. A guide to writing these case reports can be found here: http://www.ficm.ac.uk/sites/default/files/expanded%20case%20summaries%202011.pdf.

Guidance is being formalised by educational supervisors and will be reviewed before being released; so watch this space for changes.

It is very easy to find this task overwhelming, especially if you are not careful with the subject matter. For instance don’t say “how should we treat traumatic brain injury?” as this is a huge topic. Focus on a specific aspect of the condition or treatment. “What is the evidence of the use of thiopentone coma in treatment of TBI?” or “Is there a role for decompressive craniectomy in TBI?”

Workplace Based Assessments / Supervised Learning Events

We can feel your pain! Even as a PICM Grid trainee you still need to get signed off for your paediatric CCT. This means you need to pass your ARCPs and unfortunately this means you have to complete the requisite number of work based assessments. We know they have not been designed with PICM in mind, but there is no getting around them.

The majority of ARCP panels realise the WBAs are not designed with us in mind so think out of the box and use them flexibly.

Mini CEXs for supervised retrievals, DOCS for death or discharge summaries, HCATs for leading ward rounds, ACATs after admitting then handing over a complex patient… the possibilities are endless. Check the RCPCH websites for up to date information on the number of WBAs required. Click on RCPCH Assessment Guidance for PICM trainees.

ARCP panels are being increasingly strict about getting these done throughout the year. Trainees who have completed them all in the month before the ARCP dates have not been given Outcome 1.

START

You will have to complete the Specialty Trainee Assessment of Readiness for Tenure. This is a formative assessment designed to ensure you are on target to be fully prepared for life post CCT. Half of the assessment is on general paediatric subjects (child protection, prescribing etc) and the other half will be PICM specific. There is extensive guidance available at http://www.rcpch.ac.uk/training-examinations-professional-development/assessment-and-examinations/start/start. Please note that although this is not a summative assessment (ie. you are not going to be failed) the board can recommend that you undertake extra training in specific areas. For instance if you are assessed as being below competent for the child protection station the assessor may recommend extra training and evidence of improvement.

Your ARCP panel will want to see this evidence before they sign off your CCT. Therefore undertaking START during ST7 is a very good idea as it will allow you time to complete any remedial actions before your final ARCP comes around.

Sign off

There are several aspects that need to be signed off to gain your CCT in paediatrics with subspeciality training in PICM.

Firstly all the general paediatric stuff – WBAs, START and ARCPs.

Your educational supervisors will need to sign off your annual trainer’s reports and CCT application stating you have covered everything required by the curriculum.

This includes your anaesthetics and case reports.

Lastly someone on the RCPCH PICM ISAC also has to be satisfied that you have done everything needed.  They have access to your Kaizen portfolios and on at least a yearly basis will be looking though them to ensure you are on track. Each year they fill in a CSAC progression form which will feed back to your ARCPs and they also have to sign off your CCT application.

There is currently no competency booklet that you need to get signed (though there are old versions of ICTPICM Competencies floating around). We are working on this. The best way you can show you are on track is to keep your e-portfolio ticking over – WBAs, skills logs, PDP, supervision meetings, uploading your case reports, ticking off and cross referencing areas of the curriculum that you have covered.

Fellowships

No one expects you to be totally ready for consultant posts as soon as you walk out of two years of PICM Grid training. In the past it was considered almost essential to go abroad and do a fellowship in a large PICU (Melbourne, Sydney, Toronto, Vancouver etc) and if you want to you will benefit from and enjoy the experience. There are of course very good opportunities in some of the larger PICUs in this country. These can be at senior trainee levels in large units or in more specialist roles (such as ECMO fellow). It is also worth thinking out of the box and looking at what specific things your desired NHS Trust may want out of their next PICU Consultant. Simulation fellow post, Darzi fellowships, NHS England Innovation fellowships are all things that may tailor you to your favoured post. Whatever you decide on make your plans early. All the large PICUs both abroad and in the UK are filling these posts from two years in advance.

 

Picu on Slack

For networking, keeping in touch, file-sharing and general banter, join us on www.picu.slack.com using your nhs based email address. It’s free and you can also download the SLACK app onto your phone for easy access. It’s a great forum open to grid and non grid trainees and receive updates on educational opportunities. It will also be a platform for webinar broadcasts live from our Masterclasses.

 

And finally

As we said before, we are here to help and advise. If you have any questions or concerns about your training please get in contact with us on picstraineerep@gmail.com. We will either know the answer to your question or know who to get the answer from.

 

Updated 23/05/17