Foundation trainees in intensive care: The potential for a formal curriculum?

As a foundation year 2 (FY2) doctor with an interest in medical education, who recently enjoyed a four-month intensive care medicine (ICM) rotation, the article by Blair and Baldwin really resonated with me. ¹ As they highlight, the intensive care unit (ICU) offers invaluable and unique opportunities to junior trainees. On reflection, the difficult conversations and emotionally challenging situations I experienced have made me a better doctor and provided me with non-technical skills which I have since applied outside the ICU. From a training perspective, whilst many foundation trainees like me may be interested in a career in ICM, others rotating through the specialty may not be. Therefore, in order to advocate for greater integration of ICM into foundation training, there needs to be clear awareness of the foundation programme curriculum and how trainees can achieve these in ICM, whilst also recognising the unique, transferable skills of ICM to other specialties. The generalisability of ICM experience is evident in the 2019 internal medical training (IMT) curriculum which mandates a minimum of 3 months ICM experience. ² Notably, the learning outcomes for these trainees highlights the non-technical aspects of ICM, an area which seems equally applicable to foundation trainees.

The Faculty of Intensive Care Medicine ‘Critical Foundation’ framework, highlighted by the authors, is a valuable resource which suggests potential learning outcomes for trainees, emphasises the benefits of such rotations, and advocates for more ICM foundation posts. ³ This appears mainly based on case studies of good educational practice in ICUs across the UK. In order to build on this, I suggest that a concise, but formal ICM curriculum for foundation doctors that explicitly identifies the valuable, transferable skills of ICM, could be the next step. Alongside identifying technical and non-technical competencies that are obtainable in a four-month rotation, this curriculum could incorporate outcomes from IMT, acute care common stem (ACCS) and core anaesthesia curricula, allowing shared ‘junior’ teaching sessions – already a part of some ICU’s educational activity. Such an approach is recognised by the General Medical Council’s ‘Excellence by design: standards for postgraduate curricula’, which clearly states the need for transferability of skills and “interdependencies” between training programmes. ⁴ Additionally this integration could empower foundation doctors to progress towards the next stage of acute care training.

Looking forward, the growth of post-foundation ‘clinical fellow’ posts presents educational challenges for postgraduate medical training, including ICM.^3,5 As such, this proposed curriculum could look at incorporating learning outcomes for these posts, as well as encouraging those in the posts to support foundation trainee education, through near-peer teaching and mentorship.

As ICM grows as an individual training specialty, the need to attract and inspire newly qualified doctors is vital. A structured and unique 4 month educational experience can be an effective way of doing this. ³ Alongside this, a curriculum can help ensure that the diverse array of ICM sub-specialties, not available in all units, are introduced to foundation trainees. Therefore, I suggest that a formalised ICM curriculum that empowers foundation trainees to make the most of their rotations could be of value.