Alternative Career Paths in ICM

Jacqueline McCarthy

In the earlier stages of my training, I disliked the discomfort I felt when patients deteriorated to a level beyond my skill set. The ICM doctors who arrived at such times clutching bags of impressive sounding drugs and equipment before whipping them away with an air of proficiency impressed me. I applied for ACCS training, hoping to join their ranks. Vocalising an interest in ICM prompted a range of responses from colleagues. “Are you sure?”….

Continue reading “Alternative Career Paths in ICM”

POCUS and the Sceptics

Alex Scott

As I was saying at the odd conference before we were so all so rudely interrupted, Point of Care Ultrasound is finally coming of age in the UK.  It has taken a while – the first diagnostic use of ultrasound was in the 1940s by a neurologist, a comparatively rapid pickup from the first demonstrations of Non-Destructive Testing for metals using ultrasound in 1928. 

Continue reading “POCUS and the Sceptics”

Knowing Your Team – Part 2

Paul Twose & Gareth Cornell

Susan McGowan, Helen Newman &
Rachel Jones

Welcome back to FICMLearning Podcasts.

In the second part of our podcast series on ‘Knowing Your Team’ we will be looking at the roles of physiotherapy and speech and language therapy in the management of critically ill patients. It is so inspiring, listening to how these specialists have an enormous amount to offer in both the acute and long-term rehabilitation of critical care patients. 

Continue reading “Knowing Your Team – Part 2”

Recruitment Blog Double: Getting a job during a time of change & Recruitment as an IMG

Liz Thomas
Shashikumar Chandrashekaraiah

A recruitment blog double from Dr Liz Thomas and Dr Shashikumar Chandrashekaraiah.

Liz discusses getting a job in a time of change and Shashikumar tells us about recruitment as an IMG.

Continue reading “Recruitment Blog Double: Getting a job during a time of change & Recruitment as an IMG”

Random Patient Generator

John Wilkinson, Janet Wilkinson, Sarah Redford, Matthew Faulds

Following on from Gilly Fleming’s blog in November where she gave a fantastic update on some of the ways teaching can adapt to the challenges of the pandemic, we wanted to share with you our experience of developing a new learning tool and applying it in such an unusual time.

Continue reading “Random Patient Generator”

Knowing Your Team – Part 1

Greg Barton,
Ella Terblanche,
Danielle Bear

Welcome back to another year of FICMLearning Podcasts.  

This is the first part of a podcast series we will be running to raise the profile of the critical care multidisciplinary team. We hope that this will highlight the vital contribution that each member of the critical care team makes to the complex management of patients on the intensive care unit and how effective collaboration between team members helps to ensure successful outcomes after critical illness. 

Continue reading “Knowing Your Team – Part 1”

Coroner’s Court – My Experiences of Giving Evidence

Liz Thomas

We are very lucky to have a well developed and longstanding coronial service – I’ve just been listening to the FICM podcast with Derek Winter and have found out it can be dated back to at least 1194. Something not covered in the excellent podcast is how it feels to be in the stand – giving evidence, so here is a blog on my experiences.

Continue reading “Coroner’s Court – My Experiences of Giving Evidence”

Clinical Lead Conference 2020

On 30th November 2020 the Faculty held its annual Clinical Leads Conference. all attendees had access to pre-recorded lectures which where then discussed in the Q and A session held on the 30th. We would now like to give access to these pre-recorded sessions and they can be access below. The recorded Q and A session is available below, we suggest watching the lectures first.

These sessions will be available until 15 January 2021.

Enhanced Care: Dean Dr Alison Pittard

ACCP Training and Accreditation – the future: Ms Rachel Pascoe, Lecturer in Nursing at University of Plymouth

Life After Critical Illness:  Immediate Past-Dean, Dr Carl Waldmann, Dr Joel Meyer, Dr Andy Slack

Changes to Clinical Commissioning of Critical Care Services – The Future? Professor Jane Eddleston, Commissioning Lead

Getting it Right First Time (GIRFT). Critical Care and possible implications for your unit: Dr Anna Batchelor, GIRFT Lead

How to set up and run a Critical Care Research Nurse Team: Ms Jade Cole, Team Lead, Cardiff Critical Care Directorate, and Research

Animation Support on ICUs: Professor David Wald

Full Conference Question and Answer Sessions: recorded on Zoom 30 November 2020

My path to critical care pharmacy and the FICM Pharmacy Sub-Committee

Emma Taylor

I originally chose to study pharmacy after being inspired by some family-friends who owned their own community pharmacy. I studied at Nottingham University, and only changed my mindset towards hospital pharmacy at the very end of my degree and managed to secure my Pre-Registration Pharmacist year in my local district general hospital. My training was excellent, I loved the clinical aspects of the job, and I was encouraged by the team to progress my career in hospital pharmacy.

Continue reading “My path to critical care pharmacy and the FICM Pharmacy Sub-Committee”

The Coroner – Part 2

Bev Frankland

This month James Sira talks to Bev Frankland about writing a statement for the coroner, as well as preparing and giving evidence at the coroner’s inquest. 

Bev is the Risk & Inquest Manager for South Tyneside and Sunderland NHS Foundation Trust. She is primarily responsible for looking after the ‘top-end’ of the investigation spectrum e.g. inquests, serious investigations and police matters.  She has several years experience supporting medical staff through the process of an inquest and in these podcasts shares some key advice.

Continue reading “The Coroner – Part 2”

WICM: Inspiring Careers in Critical Care – Dr Laura Allan

Jasmine Medhora
Laura Allan

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Laura Allan, Emergency Medicine and Intensive Care Medicine Registrar

Continue reading “WICM: Inspiring Careers in Critical Care – Dr Laura Allan”

WICM: Inspiring Careers in Critical Care – Dr Roxy Bloomfield

Jasmine Medhora
Roxy Bloomfield

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Roxy Bloomfield, Consultant in Anaesthesia, Intensive Care, Prehospital and Retrieval Medicine

Continue reading “WICM: Inspiring Careers in Critical Care – Dr Roxy Bloomfield”

WICM: Inspiring Careers in Critical Care – Dr Deborah Owen

Jasmine Medhora
Deborah Owen

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Dr Deborah Owen, Intensive Care Medicine Registrar

Continue reading “WICM: Inspiring Careers in Critical Care – Dr Deborah Owen”

WICM: Inspiring Careers in Critical Care – Dr Caroline Lacey

Jasmine Medhora
Caroline Lacey

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Dr Caroline Lacey, Intensive Care Medicine Registrar

Continue reading “WICM: Inspiring Careers in Critical Care – Dr Caroline Lacey”

WICM: Inspiring Careers in Critical Care – Alice Coulson

Jasmine Medhora
Alice Coulson

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Alice Coulson, Trainee Advanced Critical Care Practitioner

Continue reading “WICM: Inspiring Careers in Critical Care – Alice Coulson”

WICM: Inspiring Careers in Critical Care – Dr Louise Hartley

Jasmine Medhora
Louise Hartley

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Dr Louise Hartley, Consultant in Intensive Care Medicine

Continue reading “WICM: Inspiring Careers in Critical Care – Dr Louise Hartley”

The Online Revolution: Playing your part as a Virtual Educator

Gilly Fleming

The COVID-19 pandemic is a global healthcare emergency and the NHS is facing an unprecedented crisis. During the first wave in March and April 2020, the immediate priority was understandably on clinical delivery of safe and efficient care for patients presenting with a novel disease process. This led to the suspension of many “non essential, non-covid” services, and included widespread disruption to medical education at all levels, from undergraduate to postgraduate.

Continue reading “The Online Revolution: Playing your part as a Virtual Educator”

WICM: Inspiring Careers in Critical Care – Nicola Clark

Jasmine Medhora
Nicola Clark

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Nicola Clark, Physician’s Associate, Intensive Care

Continue reading “WICM: Inspiring Careers in Critical Care – Nicola Clark”

WICM: Inspiring Careers in Critical Care – Dr Joanna Thirsk

Jasmine Medhora
Joanna Thirsk

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

Dr Joanna Thirsk, Anaesthetics and Intensive Care Medicine Registrar

Continue reading “WICM: Inspiring Careers in Critical Care – Dr Joanna Thirsk”

The Coroner – Part 1

Mr Derek Winter DL

This month is the first in a two-part series looking at the work of the coroner. James Sira talks to Derek Winter about the role of the coroner, medical examiner, and the coroner’s inquest.  

Derek is HM Senior Coroner for the City of Sunderland and was appointed as one of the two Deputy Chief Coroners of England and Wales in 2019. He has conducted a wide range of cases in the 15 years he has spent as a coroner and has modernised the Sunderland coroner service. 

Most intensive care doctors will at some point in their career be required to provide a statement for or give evidence at a coroner’s inquest, and this can be a daunting experience.

Continue reading “The Coroner – Part 1”

Case of the Month #11

Louise Hartley

A 40 year old male was admitted to intensive care unit requiring intubation and ventilation for community acquired pneumonia. He developed acute respiratory distress syndrome (ARDS) and on day 2 commenced an atracurium infusion for worsening hypoxaemia.

Despite two sessions of prone ventilation he failed to improve and required high ventilatory pressures. On day 5 he was placed on venovenous extracorporeal membrane oxygenation. (VV ECMO).

Continue reading “Case of the Month #11”

Max & Kiera’s Law

Dale Gardiner
Phil Walton

On the 20th May 2020, the legislation relating to consent for organ donation changed to an opt out system.  As critical care plays a pivotal role in the organ donation process, these two podcasts give a clinical perspective on the importance of the new legislation and how it impacts on the discussions we have with family members about consent for organ donation.  

There are also some interesting anecdotes & lessons learnt from the awareness campaign and implementation strategy used in Wales when this law was first introduced in 2015. 

Continue reading “Max & Kiera’s Law”

October – New Academic Year and A New WICM Chair

Liz Thomas

New academic year – new blog post!

Hello – I’m Liz Thomas – a consultant in intensive care medicine and anaesthesia and I am delighted to have taken over the role of Chair of the WICM committee from Dr Rosie Baruah. I have been on the WICM committee for almost 12 months.

Continue reading “October – New Academic Year and A New WICM Chair”

Max and Keira’s Law – The Bill That Was Pulled Out Of A Bowl

Claire Williment

Max and Keira’s Law came in to force on the 20th May 2020 and brought renewed hope to the thousands of people on the UK transplant waiting list. The legislation introduced ‘opt out’ as the legal basis for organ donation consent in England and is expected to lead to an additional 700 transplants a year. However, the path to getting the new legislation in place was far from smooth.

Continue reading “Max and Keira’s Law – The Bill That Was Pulled Out Of A Bowl”

Frailty

Simon Conroy

This month Matt Bromley talks to Simon Conroy about frailty and its implications for critical care. Simon is a professor of geriatric medicine in Leicester and the clinical lead for the specialised clinical frailty network.  

He has a particular interest in translational research in the acute care setting and has made significant improvements in the recognition of frailty amongst older people presenting acutely to hospital and how this can be used to inform decisions about clinical management. 

Continue reading “Frailty”

Preparing for the FFICM (final) examination – an examiner’s view

Victoria Robson
FFICM Exam Chair

FFICM is a ‘high stakes’ exam taken by ICM trainees, and is mandatory before entry it stage 3 training. This article aims to give some tips and pointers to trainees who are preparing for this exam, written by an experienced FFICM examiner.  

Continue reading “Preparing for the FFICM (final) examination – an examiner’s view”

Coffee afternoons, baby yoga and a masters?

Samantha Batt-Rawden

As a dual trainee who had never jumped off the training treadmill, I was looking forward to my maternity leave. I had pictured long coffee afternoons with other new mothers, taking up baking and trying my hand at baby yoga. Heck, I had thought I was going to be so refreshed by what I thought would be a break I might even sign up to do a part-time Masters in my ‘time off’.

Continue reading “Coffee afternoons, baby yoga and a masters?”

Simulation Part 2

Andrew Jacques, John Fletcher, Manoj Wickramasinghe

Welcome back to the simulation series. 

In this second part Matt Bromley, a senior intensive care medicine trainee, talks to a number of simulation enthusiasts about the practicalities of setting up and delivering simulation training on intensive care. 

Andrew Jacques is a consultant in intensive care medicine in Reading and has been instrumental in developing in-situ simulation training on their intensive care unit. He is also the simulation lead for the education sub-committee of the Faculty of Intensive Care Medicine. 

John Fletcher is an advanced critical care practitioner in the Leeds Teaching Hospitals NHS Trust who has many years of experience as an ICU nurse and educator. He joins their Simulation Fellow, Manoj Wickramasinghe, in talking about the development of a high-fidelity intensive care simulation course that has a strong focus on MDT involvement. 

Continue reading “Simulation Part 2”

Working as an International Medical Graduate with a BAME Background during COVID-19

Shashi Chandrashekaraiah, Sushruth Raghunath, Avinash Jha, Arif Akbar, Ikenga Samuel & Mohammed Elshamy

International Medical Graduates (IMGs) account for approximately 25% of the current UK trainee doctor workforce and are predominantly of black Asian and minority ethnic (BAME) backgrounds. There has been a lot of discussion during the current COVID-19 crisis about IMGs and their contribution to the NHS, VISA/Immigration health surcharge and the more important topic of increased mortality among BAME doctors from COVID-19.

Continue reading “Working as an International Medical Graduate with a BAME Background during COVID-19”

Decision Making Part 2

Dominic Bell

Welcome back to the difficult decision making series of podcasts.

In this second part James Sira, a consultant in intensive care medicine, talks to Dominic Bell about how to approach decisions around admission to critical care using a framework based on a clearer understanding of futility.

Dominic has been a consultant in Intensive Care Medicine for more than twenty years. He has a degree in medical law and has been an expert witness for the Court of Protection on end of life decision making, and for the GMC on fitness to practice investigations. He has also worked as an assistant coroner and has been an expert witness for the police.

Continue reading “Decision Making Part 2”

Who still believes in Santa and science?

Matt Morgan

As I look through my office window at yellowing patches of summer grass, it may seem strange to talk about Christmas. But these are strange times. I remember being told that there are three stages of life – first you believe in Santa, then you don’t believe in Santa, then you are Santa.

Continue reading “Who still believes in Santa and science?”

Case of the Month #5

Colin McAdam

A previously well 76-year-old male presents to ED having been found on the floor at home by a relative. Collateral history reveals ‘flu-like’ symptoms and headache within the last week.

On arrival he is soiled, agitated and combative with a GCS of 9/15 (E2 V2 M5). There are no obvious localising neurological signs. Pupils are equal and reactive. Temperature is 39.0.A basic delirium screen in ED is negative (urine dip and chest x-ray). As you continue assessing the patient, he has a short-lived generalised tonic-clonic seizure.

  1. What is your differential diagnoses?
  2. How would you investigate further?
Continue reading “Case of the Month #5”

The academic response to COVID-19

Tony Rostron

For those of us who contribute to patient facing research, there were signals in early March that our working lives were about to change. The safety implications related to recruitment of and sampling from patients in studies who were potentially infected with SARS-CoV-2 needed to be considered. As a result many NIHR portfolio studies, supported by their funders, decided to pause recruitment.

Continue reading “The academic response to COVID-19”

Case of the Month #4

Pete Hersey

A 67 year old man has been admitted overnight to the intensive care unit.  He presented with flu-like symptoms and a non-productive cough.  His wife reported that he had been ‘seeing things’.  Investigations revealed hypoxaemia, lobar consolidation, neutrophilia and a raised lactate dehydrogenase.

You suspect the patient may have Legionnaires’ disease.

Continue reading “Case of the Month #4”

#BetterTogether: The Critical Care Team

Sarah Clarke

One of the difficult jobs during this pandemic is not only our dedication and commitment to best care of our patients, but the supervision and support of those less familiar to the Critical Care environment. This may be our own trainees, but also others for whom the decision to come to our ‘space’ hasn’t necessarily been their own; and includes other specialty trainees, senior medical staff, nursing colleagues and allied health professionals.

Continue reading “#BetterTogether: The Critical Care Team”

Decision Making Part 1

Danny Bryden, Dale Gardiner

In the first part of this series, Danny Bryden and Dale Gardiner give their views on decision making, particularly with respect to admission to critical care. They also discuss wellbeing, and the impact of COVID-19. Danny is vice dean of the FICM. Dale is a consultant in anaesthesia and ICM in Nottingham, and is the national clinical lead for organ donation with an interest in medical ethics.

Continue reading “Decision Making Part 1”

Case of the Month #3

Rosaleen Baruah

A 54 year old woman with a history of hypertension presented to the emergency department with a sudden onset severe headache. Her GCS was E3 V3 M6 on arrival, but deteriorated over the next 2 hours to E3 V2 M5. A CT brain demonstrated an intracerebral haemorrhage and a CT angiogram confirmed a ruptured middle cerebral artery aneurysm. She was intubated and ventilated for transfer to the regional neurosciences unit where she underwent a successful endovascular coiling procedure the following morning. On sedation hold she is now GCS E1 VT M1. 

What are the potential causes of her reduced level of consciousness?  

Continue reading “Case of the Month #3”

Case of the Month #2

Kyle Gibson

A 40 year old male was found unresponsive in the garden. Initial GCS was 9 (E3V2M4) which deteriorated to 7 (E2V2M3) on arrival to the emergency department. ECG and CT brain were both normal. An ABG demonstrated a high anion gap metabolic acidosis (pH 7.0) with an increased osmolal gap (>10mOsm/kg). In view of unexplained decreased level of consciousness along with high anion gap acidosis and high osmolal gap, ethylene glycol toxicity was considered to be the most likely diagnosis.

Q1 – How does ethylene glycol ingestion present?

Continue reading “Case of the Month #2”

Finding a consultant post: Why district general ICM was the right choice for me

Debbie Kerr

The final years of training can be somewhat of an emotional roller-coaster – you’re excited to finally see the ‘reward’ for all those years of hard work, but anxious about taking on a new post and responsibilities. Perhaps one of the more difficult considerations is where you want to work as a consultant, and how this will influence your career progression after training… it certainly was for me! In this blog, I wanted to share my thoughts about finding a consultant post, and why becoming a district general ICU consultant was the right choice for me.

Continue reading “Finding a consultant post: Why district general ICM was the right choice for me”

‘Stepping down’ from Critical Care and into freefall: a patient’s perspective

Catherine White

What happens to your patients once they leave ICU?

What may be the end of the story for critical care healthcare professionals is usually the beginning of a long, difficult and sometimes very lonely journey for patients and their relatives.

Continue reading “‘Stepping down’ from Critical Care and into freefall: a patient’s perspective”

Capacity in Critical Care

Kate Rimmer

The issue of mental capacity in the critical care environment can be fraught with difficulty and can cause anxiety to staff working in these environments.  It is important for all staff involved in the care of the critically ill to understand the law in relation to capacity and consent and have knowledge of the process of making a capacity assessment. 

Continue reading “Capacity in Critical Care”

Time to Change!

Nish Desai

The time has come; Striking the Balance our first ever WICM meeting on 27 September 2019, on a rather wet Friday at the Royal College of Anaesthetists. In all the excitement leading up to the event, I recall speaking to Lucy Rowan at the Faculty the day before to discuss the day and shared my rather nervous feelings about writing this blog.

Continue reading “Time to Change!”

Being Male in Medicine – Changing Social Gender-Based Expectations

Rosie Baurah & Mark Hughes

On the 2nd of June I had the pleasure of attending the inaugural Woman In Surgery Scottish Meeting at the Royal College of Surgeons in Edinburgh. The programme was packed full of enthusiastic and informative speakers – and one of them, Mr Mark Hughes, an ST8 in neurosurgery who I have the privilege to work with at the Western General Hospital in Edinburgh, also happened to be male!

Continue reading “Being Male in Medicine – Changing Social Gender-Based Expectations”

Neurocritical Care – why I love what I do and succession planning!

Manni Wariach

After two amazing years at Southampton Neuro ICU and 50,000 miles on the clock, I am moving back to London to be closer to my girls. Thinking about succession planning for my post has allowed me to enthuse to the Wessex ICM trainees about how rewarding my job has been here. So why should they consider applying for my job?

Continue reading “Neurocritical Care – why I love what I do and succession planning!”

Returning to Work

Rosie Baruah

There is increased awareness amongst the medical royal colleges of the challenges of returning to work after a long period away, and the need for this to be a structured, managed process.  The Faculty is developing its own Return to Work (RTW) guidance, which will be a synthesis of the guidance provided by its constituent colleges.

Continue reading “Returning to Work”