Intensive Care Medicine CESR Portfolio Guide

Standard expected: Level 4

• Understand, incorporate and implement national legislation (e.g. Health and Social Care Act 2012 and the Equality Act 2010) into everyday practice
• Successfully and ethically incorporate information technology and governance, according to national legislation, into patient care
• Can communicate & document effectively, according to ethical and legal frameworks to promote the highest standards of healthcare
• Know how to interpret, construct and apply ethical and legal frameworks into all areas of clinical governance
• Demonstrate the highest professional behaviours, individually and corporately
• Continually strive to enhance and integrate knowledge into clinical practice and the NHS organisation as a whole, whilst observing legal and ethical obligations

Standard expected: Level 4

• Adhere to national legislation and guidelines relating to safeguarding children and other vulnerable groups of patients such as those with protected characteristics
• Contribute towards quality improvement, communicate effectively and share good practice
• Demonstrate a commitment to learn from critical incidents and adverse events as well as sharing the learning points from these experiences
• Communicate effectively with patients, their families and professional colleagues whilst recognising and effectively managing any barriers to effective communication
• Optimise care of critically unwell patients by the critical appraisal of recent medical literature and the application of evidence-based guidelines
• Ensure patient safety is the key priority at all times in their clinical practice both within the intensive care unit and in the wider clinical environment of the hospital

Standard expected: Level 4

• Remain up to date in their reading of current research literature and best practice guidelines
• Have an understanding of the processes and governance of clinical research, and will be able to communicate this to patients and their relatives where appropriate
• Be able to critically appraise clinical literature, and to apply this, when appropriate, to their clinical practice
• Use their knowledge of the ethical principles of practising medicine, and the legal framework associated with this in modern healthcare to benefit their patients
• Have the ability to organise the collection and interpretation of data collected from their own intensive care unit and use this as a method of improving clinical services locally
• Apply information derived from population data to help inform individual treatment plans for their patients

Standard expected: Level 4

• Deliver effective teaching and training to medical students, doctors in training, colleagues and members of the wider multidisciplinary team.
• Competently assess the performance of learners objectively and deliver timely and constructive feedback on learning activities in accordance with current educational standards and best practice
• Meet any regulatory requirements of a trainer and will keep these current as well as participating in quality assurance processes to ensure excellent undergraduate and postgraduate training
• Endeavour to ensure patient involvement and feedback is integral to the delivery of education to doctors in their individual roles as well as their role as a member of the multidisciplinary team

Standard expected: Level 4

• Identify an acutely ill patient or one at risk of significant deterioration by taking account of their medical history, clinical examination, vital signs and available investigations
• Integrate clinical findings with timely and appropriate investigations to form a differential diagnosis and an initial treatment plan
• Administer intravenous fluids and inotropic drugs as clinically indicated utilising central venous access where required and monitoring the effectiveness of these treatments with invasive monitoring techniques
• Stabilise and initiate an initial treatment plan for a critically ill acute surgical, acute medical or peri-partum patient including those with sepsis or post-trauma and institute timely antimicrobial therapy
• Provide definitive airway management and initiate and maintain advanced respiratory support
• Undertake the transport of mechanically ventilated critically ill patients outside the Intensive Care Unit when required
• Communicate effectively and in a timely manner, with fellow members of the multi-disciplinary team including those from other specialties and make an accurate, legible and contemporaneous entry in the patient’s medical record
• Where escalation of care is required, be able to arrange this and provide a succinct structured handover to clinical colleagues
• Recognise when a patient has the potential to deteriorate or requires future treatment escalation and be able to provide explicit instructions regarding an ongoing treatment plan and contact details should a further review be required
• Have the ability to communicate with a patient's family, in terms they can understand, the patient's clinical condition, current and likely future treatment options and where possible, an indicative prognosis in an empathetic and understanding manner
• Be mindful at all times that whilst assessing and treating patients they must maintain optimum safety for their patients by recognising any limitations of their current clinical environment, the available equipment and personnel and employing best practice guidelines where these exist

Standard expected: Level 4

• Initiate, perform, interpret and integrate point-of-care testing, radiological and laboratory investigations with their patient’s clinical findings
• Integrate knowledge, skills and investigations to treat a patient who is deteriorating and institute or escalate organ support therapies
• Perform invasive procedures to aid the diagnosis and management of a critically ill patient, and provide advanced organ-support therapies as well as monitor the effectiveness of these therapies in improving the patient's overall condition
• Use their knowledge, apply their skills, and interpret investigations and advanced therapeutic monitoring data to manage critically ill patients, including safe prescribing practices and advanced organ system support modalities, throughout the course of their critical illness

Standard expected: Level 4

• Have the knowledge and understanding of the care of patients undergoing a wide range of operative procedures
• Be expert in resuscitating and stabilising patients before and after a wide range of operative procedures
• Have an awareness of and be able to treat the common complications of a broad range of operative procedures
• Lead and contribute to the skill mix of a multidisciplinary team that will deliver the perioperative management of patients undergoing surgical procedures

Standard expected: Level 4

• Identifying and limiting the physical and psychosocial consequences of critical illness for patients and families paying particular attention to the assessment, prevention and treatment of pain and delirium
• Communicating the continuing care requirements of patients at discharge from both ICU and hospital to healthcare professionals, patients and relatives. This will include the patient’s plan for ongoing care, medical follow up and rehabilitation
• Facilitating discussions focused on how to manage end of life care with patients and their families. The process of withholding or withdrawing life-sustaining treatments and providing palliative care whilst maintaining respect for cultural and religious beliefs will form an important element of this.
• Diagnosing death using neurological criteria and diagnosing death using circulatory criteria in time sensitive scenarios (eg donation after circulatory death).
• Identifying likely organ donors, working collaboratively with specialist nurses for organ donation and facilitating the process of organ donation, including providing appropriate physiological support to the organ donor

Standard expected: Level 4

• Providing support to colleagues and contributing to the management of acutely unwell patients outside of the critical care unit when requested to do so
• Having the leadership and communication skills to head a culturally diverse multidisciplinary team providing care to an equally diverse range of patients on the critical care unit
• Involving patients and their relatives in as many treatment decisions as circumstances will allow whilst ensuring patients and relatives are kept abreast of the current treatment plan and options
• Actively participating in the development and application of systems and processes designed to improve the delivery of safe care for critically ill patients
• Understanding and being able to describe the special requirements of a mass casualty incident

Standard expected: Level 3

• Conduct comprehensive pre-anaesthetic and pre-operative checks
• Demonstrate knowledge of anatomy, physiology, biochemistry and pharmacology relevant to anaesthetic practice
• Describe the functioning principles of standard equipment used within anaesthetic practice and understand the physical principles governing the operation of such equipment and the clinical measurements derived from them
• Pre-operatively assess ASA 1-3 patients’ suitability for anaesthesia, prescribe suitable pre-medication and recognise when further investigation or optimisation is required prior to commencing surgery and adequately communicate this to the patient and their family
• Safely induce anaesthesia in ASA 1-3 patients and recognise and deal with complications associated with the induction of anaesthesia
• As a member of the multi-disciplinary theatre team, maintain anaesthesia for the relevant procedure, utilise appropriate monitoring and effectively interpret the information it provides to ensure the safety of the anaesthetised patient
• Recognise anaesthetic critical incidents, understand their causes and how to manage them
• Safely care for a patient recovering from anaesthesia and recognise and treat the common associated complications whilst providing appropriate post-operative analgesia (including that via regional and neuraxial blockade), anti-emesis and fluid therapies
• Provide urgent or emergency anaesthesia to ASA 1E and 2E patients requiring non-complex emergency surgery
• Identify patients with difficult airways, demonstrate management of the ‘cannot intubate cannot oxygenate’ scenario in simulation, and be familiar with difficult airway guidelines

Standard expected: Level 3

• Be able to manage an acute unselected take
• Manage an acute specialty-related take
• Be capable of providing continuity of care to medical in-patients, including management of comorbidities and cognitive impairment
• Know how to manage patients in an outpatient clinic, ambulatory or community setting (including management of long term conditions)
• Have the ability to assess and treat medical problems in patients in other specialties and special cases
• Make an active contribution to the functioning of a multi-disciplinary clinical team including effective discharge planning
• Deliver effective resuscitation and manage an acutely deteriorating patient
• Care for patients who require end of life care as well as those who require palliative care

Standard expected: Level 3

• Understanding and assessing the perioperative risks associated with patient comorbidities, emergency anaesthesia and surgery and the implications of concomitant drug therapies in these patients
• Being competent in the postoperative care of common acute and chronic medical conditions commonly found in these patients
• Being aware of the effects of major neurological surgery on these patients and the associated immediate postoperative management of these patients including the common complications and providing optimal analgesia
• Knowing the factors which influence the intensity, levels of care and the clinical environments where the necessary care can be safely delivered to patients with neurological disease
• Recognising and treating respiratory and cardiovascular dysfunction with their associated complications commonly encountered in these patients
• Effectively assessing and managing other perioperative conditions and complications encountered by pre- and post-operative neurosurgical and neurological patient
• Being able to competently assess a patient’s neurological status and provide appropriate support where necessary
• Having a thorough understanding of the pathophysiology of raised intracranial pressure including the options for its operative and non-operative management
• Providing immediate treatment of perioperative emergencies in neurosurgical and neurological patients and knowing when to seek senior help and support

Standard expected: Level 3

• Know and can effectively manage the major anatomical, physiological and psychological differences between adult and paediatric patients
• Appreciate the pathophysiology of common paediatric emergencies, recognise their presentation and can provide initial management until expert help or specialist assistance is available
• Are able to provide emergency and continuing cardiovascular support to a child until expert help or specialist assistance is available
• Are capable of resuscitating a child, know when to seek specialist help and support via their local paediatric retrieval team whose processes they are familiar with
• Are competent to provide elective and emergency airway management and mechanical ventilation to a child including induction of anaesthesia for intubation
• Practise in accordance with national legislation and guidelines relating to safeguarding children in the context of critical care

Standard expected: Level 3

• Assessing the perioperative risks associated with these patients’ co-morbidities, emergency anaesthesia and surgery and the implications of their concomitant drug therapies
• The postoperative care of common acute and chronic medical conditions commonly found in these patients
• Assessing the implications of the type and site of surgery for these patients’ immediate postoperative management and the potential complications, which they can manage effectively whilst providing optimal analgesia
• Considering the factors which influence the intensity, levels of care and the clinical environments where the necessary care can be safely delivered to these patients
• Treating respiratory dysfunction and complications in these patients
• Treat cardiovascular dysfunction and complications in these patients including understanding advanced monitoring techniques and provision of mechanical circulatory support
• Assessing and managing other perioperative conditions and complications encountered by pre- and post-operative cardiothoracic surgery patients
• Recognising and providing immediate treatment of perioperative emergencies and know when to seek senior help and support

Standard expected: A higher capability level than that required in the curriculum HiLLOs

• The Special Skills Year areas of approved experience must be at a higher capability level than that required in the curriculum HiLLOs. This would mean that an SSY in Medicine and Anaesthesia would require further experiential learning and acquisition of skills and knowledge to a Capability Level of 4, as would the specialty ICM placements of Neuro, Paediatric & Cardiac ICM.

Currency Window

Evidence of skills or experience more than seven years old should not be submitted, as it would not demonstrate maintenance of the competence. This however does not necessarily mean a training placement should be repeated if it took place greater than seven years previously. Instead, evidence should be submitted which demonstrates the maintenance of the competence. Last seven years Whole Time Equivalent of practise (does not need to be consecutive).

Evidence Volume

800-1000 pages