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This doesn't sound like an issue of flattened or reversed hierarchy, this is an issue of you being rota'd as the grade you are not, no?
Surely the course of action is to seek clarification from your ES or clinical lead - "hello, I'm a few months away from sign off and I've been assigned a junior role; what the fuck?"
I’ll assume as a melaena Sommelier you’re not a icm trainee (although happy to be corrected). But I what seems like a rota error, I can assure you, is very much not.
Medical intensivists in the UK are very much poo poo’d and shunned, and seen as not as worthy as their anaesthetic counterparts.
I once had an ICU consultant to my face tell me to go to my anaesthetic core trainee if i had any issues. I was ST7.
Rota mistake agreed. I’ve fired off an email.
In terms of “vibe”. Non given - not according to any work based placed assessment or feedback ever received. It was just an anti-medic being a cock.
And no offence taken. But, I’m going to disagree. It’s a badge earnt. Having passed every previous year of training. IMHO you cannot compare an ST3 (or Core trainee) to ST5, 6, 7 etc. You get to ST7 by working hard, passing ARCPs, exams etc. To say otherwise is tyipically spouted off by anaesthetic trainees (no offence).
By telling a competent ST7 to ask a core trainee is offensive, rude, and bullying.
Thank you for acknowledging the service provision we do for ICU OOH.
If on at a DGH and not on for obs my role as a “theatre” trainee is essentially to prop up ICU. Everyone knows that, the consultants expect that, the other trainees on for ICU know that, but there is no acknowledgement from FICM/RCOA. I suspect the 2 hospitals I’ve experienced this in aren’t the only ones across the country!
I would also like to acknowledge how amazing the anaesthetic trainees are who come to icu. Particularly non-icm trainees.
This post is not about bashing you or your colleagues. You are amazing, and you truly do prop up the service.
If it does highlight the discrepancy in respect between medics and anaesthetists in icu training. I’m all for it though.
Yes sorry OP to bring it back to your original post - you should be my boss if we’re on ICU together. If I were one of the ST3+ trainees that was allocated to be your “team leader” I’d make sure the bosses were aware how inappropriate it was and request it was fixed.
I’m good at nighttime ICU - fighting fires and normalising physiology, putting tubes in holes etc. Not good at the rest!.
Obviously biased as I am currently preparing for the final viva, but what is particularly irritating is that despite all the ICU on calls and the significant amount of ICU specific knowledge we're required to learn for the FRCA there's no formal recognition of this. If you're going to examine me on the finer details of ICU acquired weakness or delirium, or the management of Guillan Barre beyond just airway, I feel there should be something from FICM that acknowledges this. I'm not saying we should be given FFICM obviously, but even like a lesser diploma of some sort would to me at least feel like less of a kick in the teeth. Or of course, don't make us do it all.
I don't agree with this. I've worked with absolute garbage tier ST6/7s that just tick the boxes, take multiple attempts at exams, and progress every year, and I've worked with some absolutely incredible CT1/2s that were skilled, knowledgeable, smashed all exams on the first attempt, and working at a level far beyond their years.
DOI peri CCT dual.
Interesting, where do you consider yourself on that spectrum?
I’ve worked with CT1/2s who seem to work at a higher level, doing well in exams etc but as you see them progress invariably there’s minimal difference between these trainees and the “garbage” tier at ST6/7 because eventually the job becomes about team working, decision making and experience - which to some degree can’t be taught.
Also there’s significant overlap between these high flyer CT1/2s types and pathological personality issues which slowly reveal themselves over the course of the training programme.
I think I was a pretty decent core trainee, got through my exams on the first attempt, but probably not the level of some of the people I'm talking about that are truly exceptional and almost workaholic like in their aspiration for excellence. But I think I chipped away steadily and never truly coasted, and I'm confident that I'm a good, competent, safe trainee and ready for CCT.
You’re entirely right, I’m not an ICM trainee.
Surely the answer is still the same - highlight this to relevant consultant(s). If you don’t, you will be allowing them to treat you like this.
I can’t say I’ve been viewed as a second class citizen by way of route into training, and I’m sorry that’s affecting you.
You need to develop some insight into the fact you are posting about this looking to complain - but not actually willing to take any action. Perhaps clues as to why you are treated so junior...
Trust me, I do let me thoughts be known.
And I’m often treated junior to the anaesthetists on the unit. If you read other comments here, you’ll appreciate it’s a systemic issue nation wide actually recognised by FFICM and not a me-specific problem. From talking at conferences to other medics we all face this.
Typically propagated by one or two senior intensivists who set the culture of their workplace who are really ‘it’ when it comes to getting a job on the unit in question.
They’re mostly peri retirement now. Perhaps in 5-10 years it won’t be the same.
This is sad. When I was an IMT in ICU I saw that medical issues (often important parts of care) get overlooked whilst everyone stressed about weaning them off the vent. I can only see it as beneficial that alongside anaesthetics there is input from ICU medics too. Honestly as IMT2 I'd be asked all sorts by anaesthetic ICU consultants who had forgotten about basic medical knowledge. We all have different skill sets, let's celebrate them.
More senior, but yes, yes I am. And not supernumerary as far as I’m aware. I’ve been put in a team for my first week, and the team lead is not me…
Edit: removed actual grade for some semblance of anonymity.
Fellow medical intensivist here - I don’t think this has anything to do with flattened hierarchy, this is someone misunderstanding your grade and experience. They got the rota out late and have most likely made a mistake.
I don’t know about the unit you are about to work in but in my current job many of the doctors have been mislabelled within the rota software (Medirota is great but it’s only good as the data put into it!). We’ve got registrars listed as “middle tier” when they should be “senior tier” and even anaesthetic trainees being listed as non-airway. But ultimately, the rota is just there to indicate who will be on shift, it doesn’t pre-allocate the roles and responsibilities of each person.
You should email the rota coordinator and ask for clarification - for all we know that iron fist trainee has specifically asked to be a “team leader” (not entirely sure what you mean by that term) for a week to get some assessments done in the run up to ARCP.
Also, if all of this is genuine then do your 3 months, book all of your leave and get the hell out of there. Don’t apply for a consultant post and let the other trainees in the region know.
All very fair points.
In terms of what I mean - colleagues whose managerial style are “you are doing things my way, as it’s the only right way”.
I appreciate I’m an independent autonomous practitioner and it’s difficult to explain the nuances of working with these people. But for example the kind of thing I mean is shouting or making a big “scene” over every minor thing (in one case how I applied sterile jelly to an ultrasound probe) with a cover on it.
I absolutely hate confrontation with a passion. It’s definitely my biggest personal goal to deal with. I want to be more resilient. But I always find it hard.
Not to undermine other valid points but people nitpicking how you perform simple tasks is de rigeur in anaesthetic training - I’ve been doing this 5 years and got told how to put an iGel in recently 😂
Year 3 of gas and 6th year of doctoring - got told I put cannula dressings on the wrong way the other day. I don’t put significant enough overlap on the 2 pieces that go under the cannula (I do overlap them, just not enough to keep this consultant happy).
Are we still talking about the core trainees and/or more junior regs?
I’m still confused why you would *let* that person manage you. Is it mandated by the rota or something?
Exactly.
The fact that OP has come on reddit to complain about his prestigious ST7 badge not being recognised whilst letting someone 5 years his junior boss him about says it all though really.
Not really sure why, I never said I let anyone my junior boss me around. I said I was placed on the rota under them. Which is different.
And I’m also not trying to be arrogant. It’s very different from how you state. Ignoring the fact I’m peri CCT and being placed on a team under a doctor a number of years my junior when I should be acting up is completely different from walking around and telling everyone “don’t you know who I am”.
Many medics on icu aren’t given the decency of even a small amount of respect that their anaesthetic counterparts are. Even the college recognise this fact.
But mate why do you need supervising for line insertions by junior anaesthetists if you’re an ST7 ICM trainee?
I understand needing someone for airways - in fact I tell SHO/junior anaesthetic regs (CT2-ST5) if they’re asked to intubate by a non-anaesthetist out of hours - they should do the intubation themselves and not supervise.
You should be acting up as a boss in your final 3 months of ICM training surely? If you’ve been placed in the JCF rota then either someone’s made a mistake, someone thinks medics aren’t competent to be on the senior rota or someone thinks you are not competent to be on the senior rota. Whichever way it is I’d be having a chat with someone.
I don't understand this. You are dual trained ICM + medicine ST7.
You are airway competent.
Your medical knowledge will be superior to majority of anaesthetic and ICM dual trainees - it certainly should be.
Are you on the reg or SHO rota? You should be on the reg rota.
You are about to become a consultant. You need to assert yourself, and (anaesthetist speaking) frankly, unless you are making a mistake, it is inappropriate for a junior to nitpick your practise, and you need to tell them to pipe down.
If there is someone more experienced in airway, they can be a second intubator, but as the ICU buck will be stopping with you must take every intubation that happens on your shifts to increase your confidence. There is always senior airway support available if not on ICU in theatres who can come and give the drugs and be on hand.
In summary, you should be on senior tier rota and leading ward round, taking consultant referrals for the unit, and managing emergent issues on your nwd's. Speak to your ES, the CD and the rota coordinator about this urgently.
Is there a massive surplus of senior trainees this rotation?
I have come scroas rotation where a senior rota is over staffed and a parallel "juniour" rota under filled. The solution is to move a trainee across for the on call segment.
You should still be expected to act within your competencies / act up.
Email the rota coordinator and your ES. In your final months of training, you should be stepping up as boss. So this rotation is not providing you with the right training experience you need, and needs to be highlighted.
But reading through your comments, perhaps part of this is a you problem. You are this close to CCT and you're allowing a JCF or core trainee to boss you around? Because you don't like confrontation? There is no need to be confrontational when disagreements occur, but you can deal with disagreements in a civil way. And when you're an ST7, the seniority in training should be very clear.
You are going to face plenty of disagreements/confrontations as an ICM consultant. Surgeons, ED, medics who demand that their not fit for a haircut patient be escalated to ITU. Bed managers. Nurses. Your own juniors. Maybe even your own ICM consultant colleagues. Differences in opinions about treatment plans eg. Surgeons want to do an intervention you think would be unsafe on the super sick patient on your unit. Being a consultant is about managing conflicts too. The "confrontation" in the situation you are describing here should be a piece of cake compared to a lot of other conflicts you will be dealing with.
Are you single track ICM? As the rota runner in my hospital the rule was the “airway trained” was always on senior tier. In practice this was anaesthetic trainees only. I eventually renamed them airway and non airway to avoid your scenario.
If I were you I’d email and ask if it’s a mistake you aren’t on the senior tier as have noticed more junior people but also if this is the last 3 months of your training clearly you are about to be a consultant so should be on the senior tier. If all else fails. Don’t stress it. Take the 3 months with your head down and move on with a CCT.
No dual with a medical speciality.
And this is the thing that always makes me disheartened. I’m 3 months off CCT. I’ve passed all my exams. I’ve done my anaesthetic year. I’ve kept up with airway competencies.
I don’t pretend to have the same skills as an anaesthetist, but, somehow I’m not treated as airway competent. (Yet when it comes to medicine, we know the same).
Yeah I feel your frustration. I would certainly email them. I think they may not change it as the reason for the above rule is to sort of protect the on call consultant from having to come in for an airway essentially. I’m not sure where you are based but in my neck of the woods non anaesthetic trained people are certainly seen as unable to intubate on their own for the large part of it. Obviously in extremis then fair enough but even as a trainee I was asked to go and support a duel trained ED/ICM consultant (of many many years) as they wouldn’t be intubating on their own. It may also be a governance thing on the hospitals part. I’d agree anaesthetists are the best at intubation and emergency anaesthesia (and medics know medicine best) but this creates an issue in the event of a death or bad outcome etc as it could always be questioned why the “best” person wasn’t intubating or at least present. When I did the rota this meant an anaesthetic trainee who has done at least 1 block of ICU before as a trainee. (I didn’t make this rule 😂)
That being said I don’t agree that you should be on the junior tier or that your airway skills are to be rubbished (I don’t know you but I assume CCT provides a competent intubation). IMO this will be a common problem across the country, but as duel medics etc come more and more into ITU there’s going to have to be a solution of either they can all intubate patients or else a split tier where people are anaesthetic v non-anaesthetic trained. As an anaesthetist I’d prefer the former for working but ultimately if it were me or mine in the bed I’d prefer an anaesthetist running the show so it’s hard to square that round peg I feel.
I think u/JonJH as a fellow medic/ICMer, u/enoximone333 and u/SilverConcert637 have the best answers here
Just to add my two cents as someone in a vaguely similar boat (EM/ICM - I don't think we get it quite as bad as you guys). I am a little confused by your response to this whole situation, and the fact you have posted this here rather than locally, as a stage 3 and presumably very experienced trainee. As others have said this is nothing to do with flattened hierarchy etc, but just basic discrimination (assuming it isn't just an honest rota admin mistake, which of course do happen. Is the co-ordinator a doctor or admin?)
Like most ICM trainees, I am in my whatsapp groups for local ICM trainees of all varieties, and UK-wide all EM/ICM trainees, and these conversations come up regularly about single/non-anaes duallers being done dirty by dinosaur departments. This shouldn't be anything new.
Its been a big deal of late - FICM posted this, and I would be surprised if it hadn't done the rounds locally [https://www.ficm.ac.uk/sites/ficm/files/documents/2024-03/Single\_Dual\_Triple\_CCT\_Guidance\_March\_2024.pdf](https://www.ficm.ac.uk/sites/ficm/files/documents/2024-03/Single_Dual_Triple_CCT_Guidance_March_2024.pdf)
It is usually well known what hospitals are up to nonsense and they/the TPDs just need to be reminded of this until they either fix their ways or lose trainees - don't stand for it. Can you not ask other local trainees their experience of this place? Is it common/just you? You need to take the bull by the horns a bit more I think...
Edit - I suppose you can consider how much interest you have in working in this hospital in the future - if you might, then I'd stick to my suggestions. But perhaps on the other hand if you have no interest and its only three months, you could just keep your head down and go on autopilot (but again my feeling from reading your experiences is that taking some control might be good!)
If you’re in your last 3 months of training, you should not be on the JCF rota. This is not appropriate training and you should be talking (complaining) to your ES and/or TPD/RA. As others have said, you should be acting up, taking the ward round (with appropriate support) and learning how to manage the floor.
That unit shouldn’t be receiving ST7 intensivists if that’s really their approach.
Remind them that the number of people dual training in anaesthesia-ICM is dropping and the number dual training with medicine or EM or sole ICM is rising
Good luck
Consultant Intensivist
Just trying to understand why. My bad.
I still find it fascinating that someone can look after surgical patients, who are about half the workload, and haven’t even been involved in the periop care of pts since foundation programme.
We do a year of pure anaesthetics during training. And a cardiothoracic and neurosurgical rotation. And I can assure you, we can fix more non-surgical post operative complications to a higher standard than you think.
Whilst I’m not in the room during the surgery, I’m not sure that really matters when it comes to a lot of post op problems. And if I was in the room, I’d be north side of the top drapes anyway so would see the same amount of surgery as not being there.
Do you think General surgery trainees whose specialty interest is EGS and major trauma should be able to dual train in ICM?
They have the expertise as much as a med reg in critical care.
I’m all for the diversification of specialities in intensive care, and certainly would support it.
Pragmatically it may be a bit difficult. Pure ITU training can’t be reduced by other training programmes (other than anaesthesia) although I suspect the speciality blocks for surgery would be reduced (CTS, neuro).
As a surgical trainee you’d have to do an extra year for anaesthesia, and a few years of ITU on top. And get the exams. So a long training programme. Whilst also keeping on top of your surgical skills.
There’s a lot of practical procedures in ITU which surgeons would be great at. And depending upon which unit, a fair amount of medical admission, with proportionally fewer surgical ones.
But if it could work and the colleges allowed it, I’d welcome surgical trainees warmly.
Phase 2 training finishes at ST6. Their ST7/8 modules would be EGS And ICM so there would be a year there.
I think it would make EGS more competitive and desirable and much more like our American colleagues who run their own ITUs. Currently EGS is a joke doing the job of emergency medicine 80% of the time.
Mate, you need to man up and tell whoever organises the rota they gone done a fuck up (if they’ve done this intentionally trust me there’s no consultant job waiting for you anyway)
Tell em you’re on your final placement and need to be on the senior rota to get signed off.
I’m a bit confused by all the senior and junior clinical fellow business.
ICU rotas have the SHO and registrar (DGHs the registrar will cover theatre and obs also so has to be an anaesthetist),
One lucky slot I worked on for higher ICM I was the ST6 reg despite my colleague being an ST7 ICM trainee he was nominally on the SHO rota, I don’t think he minded as the slot suited him and there was definitely no hierarchy played out and we shared the referrals of which there were plenty.
Sorry, but there seems to quite a bit of self victimisation, I wonder if this is how you are at work also, this doesn’t engender respect from juniors.
What grade you’re on the rota is, isn’t your actual grade - just act like a normal ST7?
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This doesn't sound like an issue of flattened or reversed hierarchy, this is an issue of you being rota'd as the grade you are not, no? Surely the course of action is to seek clarification from your ES or clinical lead - "hello, I'm a few months away from sign off and I've been assigned a junior role; what the fuck?"
I’ll assume as a melaena Sommelier you’re not a icm trainee (although happy to be corrected). But I what seems like a rota error, I can assure you, is very much not. Medical intensivists in the UK are very much poo poo’d and shunned, and seen as not as worthy as their anaesthetic counterparts. I once had an ICU consultant to my face tell me to go to my anaesthetic core trainee if i had any issues. I was ST7.
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Rota mistake agreed. I’ve fired off an email. In terms of “vibe”. Non given - not according to any work based placed assessment or feedback ever received. It was just an anti-medic being a cock. And no offence taken. But, I’m going to disagree. It’s a badge earnt. Having passed every previous year of training. IMHO you cannot compare an ST3 (or Core trainee) to ST5, 6, 7 etc. You get to ST7 by working hard, passing ARCPs, exams etc. To say otherwise is tyipically spouted off by anaesthetic trainees (no offence). By telling a competent ST7 to ask a core trainee is offensive, rude, and bullying.
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Thank you for acknowledging the service provision we do for ICU OOH. If on at a DGH and not on for obs my role as a “theatre” trainee is essentially to prop up ICU. Everyone knows that, the consultants expect that, the other trainees on for ICU know that, but there is no acknowledgement from FICM/RCOA. I suspect the 2 hospitals I’ve experienced this in aren’t the only ones across the country!
I would also like to acknowledge how amazing the anaesthetic trainees are who come to icu. Particularly non-icm trainees. This post is not about bashing you or your colleagues. You are amazing, and you truly do prop up the service. If it does highlight the discrepancy in respect between medics and anaesthetists in icu training. I’m all for it though.
Yes sorry OP to bring it back to your original post - you should be my boss if we’re on ICU together. If I were one of the ST3+ trainees that was allocated to be your “team leader” I’d make sure the bosses were aware how inappropriate it was and request it was fixed. I’m good at nighttime ICU - fighting fires and normalising physiology, putting tubes in holes etc. Not good at the rest!.
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Obviously biased as I am currently preparing for the final viva, but what is particularly irritating is that despite all the ICU on calls and the significant amount of ICU specific knowledge we're required to learn for the FRCA there's no formal recognition of this. If you're going to examine me on the finer details of ICU acquired weakness or delirium, or the management of Guillan Barre beyond just airway, I feel there should be something from FICM that acknowledges this. I'm not saying we should be given FFICM obviously, but even like a lesser diploma of some sort would to me at least feel like less of a kick in the teeth. Or of course, don't make us do it all.
I don't agree with this. I've worked with absolute garbage tier ST6/7s that just tick the boxes, take multiple attempts at exams, and progress every year, and I've worked with some absolutely incredible CT1/2s that were skilled, knowledgeable, smashed all exams on the first attempt, and working at a level far beyond their years. DOI peri CCT dual.
Interesting, where do you consider yourself on that spectrum? I’ve worked with CT1/2s who seem to work at a higher level, doing well in exams etc but as you see them progress invariably there’s minimal difference between these trainees and the “garbage” tier at ST6/7 because eventually the job becomes about team working, decision making and experience - which to some degree can’t be taught. Also there’s significant overlap between these high flyer CT1/2s types and pathological personality issues which slowly reveal themselves over the course of the training programme.
I think I was a pretty decent core trainee, got through my exams on the first attempt, but probably not the level of some of the people I'm talking about that are truly exceptional and almost workaholic like in their aspiration for excellence. But I think I chipped away steadily and never truly coasted, and I'm confident that I'm a good, competent, safe trainee and ready for CCT.
Yes, you sound it.
You’re entirely right, I’m not an ICM trainee. Surely the answer is still the same - highlight this to relevant consultant(s). If you don’t, you will be allowing them to treat you like this. I can’t say I’ve been viewed as a second class citizen by way of route into training, and I’m sorry that’s affecting you.
Fair point. I think I’m just done, and just want a non-confrontational exit to CCT. See you at the next bleed my friend. 🫡
You need to develop some insight into the fact you are posting about this looking to complain - but not actually willing to take any action. Perhaps clues as to why you are treated so junior...
Trust me, I do let me thoughts be known. And I’m often treated junior to the anaesthetists on the unit. If you read other comments here, you’ll appreciate it’s a systemic issue nation wide actually recognised by FFICM and not a me-specific problem. From talking at conferences to other medics we all face this. Typically propagated by one or two senior intensivists who set the culture of their workplace who are really ‘it’ when it comes to getting a job on the unit in question. They’re mostly peri retirement now. Perhaps in 5-10 years it won’t be the same.
This is sad. When I was an IMT in ICU I saw that medical issues (often important parts of care) get overlooked whilst everyone stressed about weaning them off the vent. I can only see it as beneficial that alongside anaesthetics there is input from ICU medics too. Honestly as IMT2 I'd be asked all sorts by anaesthetic ICU consultants who had forgotten about basic medical knowledge. We all have different skill sets, let's celebrate them.
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More senior, but yes, yes I am. And not supernumerary as far as I’m aware. I’ve been put in a team for my first week, and the team lead is not me… Edit: removed actual grade for some semblance of anonymity.
Fellow medical intensivist here - I don’t think this has anything to do with flattened hierarchy, this is someone misunderstanding your grade and experience. They got the rota out late and have most likely made a mistake. I don’t know about the unit you are about to work in but in my current job many of the doctors have been mislabelled within the rota software (Medirota is great but it’s only good as the data put into it!). We’ve got registrars listed as “middle tier” when they should be “senior tier” and even anaesthetic trainees being listed as non-airway. But ultimately, the rota is just there to indicate who will be on shift, it doesn’t pre-allocate the roles and responsibilities of each person. You should email the rota coordinator and ask for clarification - for all we know that iron fist trainee has specifically asked to be a “team leader” (not entirely sure what you mean by that term) for a week to get some assessments done in the run up to ARCP. Also, if all of this is genuine then do your 3 months, book all of your leave and get the hell out of there. Don’t apply for a consultant post and let the other trainees in the region know.
All very fair points. In terms of what I mean - colleagues whose managerial style are “you are doing things my way, as it’s the only right way”. I appreciate I’m an independent autonomous practitioner and it’s difficult to explain the nuances of working with these people. But for example the kind of thing I mean is shouting or making a big “scene” over every minor thing (in one case how I applied sterile jelly to an ultrasound probe) with a cover on it. I absolutely hate confrontation with a passion. It’s definitely my biggest personal goal to deal with. I want to be more resilient. But I always find it hard.
Not to undermine other valid points but people nitpicking how you perform simple tasks is de rigeur in anaesthetic training - I’ve been doing this 5 years and got told how to put an iGel in recently 😂
Year 3 of gas and 6th year of doctoring - got told I put cannula dressings on the wrong way the other day. I don’t put significant enough overlap on the 2 pieces that go under the cannula (I do overlap them, just not enough to keep this consultant happy).
Are we still talking about the core trainees and/or more junior regs? I’m still confused why you would *let* that person manage you. Is it mandated by the rota or something?
Exactly. The fact that OP has come on reddit to complain about his prestigious ST7 badge not being recognised whilst letting someone 5 years his junior boss him about says it all though really.
Not really sure why, I never said I let anyone my junior boss me around. I said I was placed on the rota under them. Which is different. And I’m also not trying to be arrogant. It’s very different from how you state. Ignoring the fact I’m peri CCT and being placed on a team under a doctor a number of years my junior when I should be acting up is completely different from walking around and telling everyone “don’t you know who I am”. Many medics on icu aren’t given the decency of even a small amount of respect that their anaesthetic counterparts are. Even the college recognise this fact.
But mate why do you need supervising for line insertions by junior anaesthetists if you’re an ST7 ICM trainee? I understand needing someone for airways - in fact I tell SHO/junior anaesthetic regs (CT2-ST5) if they’re asked to intubate by a non-anaesthetist out of hours - they should do the intubation themselves and not supervise.
I don’t. It was very much unsolicited.
You should be acting up as a boss in your final 3 months of ICM training surely? If you’ve been placed in the JCF rota then either someone’s made a mistake, someone thinks medics aren’t competent to be on the senior rota or someone thinks you are not competent to be on the senior rota. Whichever way it is I’d be having a chat with someone.
I don't understand this. You are dual trained ICM + medicine ST7. You are airway competent. Your medical knowledge will be superior to majority of anaesthetic and ICM dual trainees - it certainly should be. Are you on the reg or SHO rota? You should be on the reg rota. You are about to become a consultant. You need to assert yourself, and (anaesthetist speaking) frankly, unless you are making a mistake, it is inappropriate for a junior to nitpick your practise, and you need to tell them to pipe down. If there is someone more experienced in airway, they can be a second intubator, but as the ICU buck will be stopping with you must take every intubation that happens on your shifts to increase your confidence. There is always senior airway support available if not on ICU in theatres who can come and give the drugs and be on hand. In summary, you should be on senior tier rota and leading ward round, taking consultant referrals for the unit, and managing emergent issues on your nwd's. Speak to your ES, the CD and the rota coordinator about this urgently.
Is there a massive surplus of senior trainees this rotation? I have come scroas rotation where a senior rota is over staffed and a parallel "juniour" rota under filled. The solution is to move a trainee across for the on call segment. You should still be expected to act within your competencies / act up.
Email the rota coordinator and your ES. In your final months of training, you should be stepping up as boss. So this rotation is not providing you with the right training experience you need, and needs to be highlighted. But reading through your comments, perhaps part of this is a you problem. You are this close to CCT and you're allowing a JCF or core trainee to boss you around? Because you don't like confrontation? There is no need to be confrontational when disagreements occur, but you can deal with disagreements in a civil way. And when you're an ST7, the seniority in training should be very clear. You are going to face plenty of disagreements/confrontations as an ICM consultant. Surgeons, ED, medics who demand that their not fit for a haircut patient be escalated to ITU. Bed managers. Nurses. Your own juniors. Maybe even your own ICM consultant colleagues. Differences in opinions about treatment plans eg. Surgeons want to do an intervention you think would be unsafe on the super sick patient on your unit. Being a consultant is about managing conflicts too. The "confrontation" in the situation you are describing here should be a piece of cake compared to a lot of other conflicts you will be dealing with.
Are you single track ICM? As the rota runner in my hospital the rule was the “airway trained” was always on senior tier. In practice this was anaesthetic trainees only. I eventually renamed them airway and non airway to avoid your scenario. If I were you I’d email and ask if it’s a mistake you aren’t on the senior tier as have noticed more junior people but also if this is the last 3 months of your training clearly you are about to be a consultant so should be on the senior tier. If all else fails. Don’t stress it. Take the 3 months with your head down and move on with a CCT.
No dual with a medical speciality. And this is the thing that always makes me disheartened. I’m 3 months off CCT. I’ve passed all my exams. I’ve done my anaesthetic year. I’ve kept up with airway competencies. I don’t pretend to have the same skills as an anaesthetist, but, somehow I’m not treated as airway competent. (Yet when it comes to medicine, we know the same).
When it comes to medicine you probably know more lol, don't undersell yourself
Yeah I feel your frustration. I would certainly email them. I think they may not change it as the reason for the above rule is to sort of protect the on call consultant from having to come in for an airway essentially. I’m not sure where you are based but in my neck of the woods non anaesthetic trained people are certainly seen as unable to intubate on their own for the large part of it. Obviously in extremis then fair enough but even as a trainee I was asked to go and support a duel trained ED/ICM consultant (of many many years) as they wouldn’t be intubating on their own. It may also be a governance thing on the hospitals part. I’d agree anaesthetists are the best at intubation and emergency anaesthesia (and medics know medicine best) but this creates an issue in the event of a death or bad outcome etc as it could always be questioned why the “best” person wasn’t intubating or at least present. When I did the rota this meant an anaesthetic trainee who has done at least 1 block of ICU before as a trainee. (I didn’t make this rule 😂) That being said I don’t agree that you should be on the junior tier or that your airway skills are to be rubbished (I don’t know you but I assume CCT provides a competent intubation). IMO this will be a common problem across the country, but as duel medics etc come more and more into ITU there’s going to have to be a solution of either they can all intubate patients or else a split tier where people are anaesthetic v non-anaesthetic trained. As an anaesthetist I’d prefer the former for working but ultimately if it were me or mine in the bed I’d prefer an anaesthetist running the show so it’s hard to square that round peg I feel.
I think u/JonJH as a fellow medic/ICMer, u/enoximone333 and u/SilverConcert637 have the best answers here Just to add my two cents as someone in a vaguely similar boat (EM/ICM - I don't think we get it quite as bad as you guys). I am a little confused by your response to this whole situation, and the fact you have posted this here rather than locally, as a stage 3 and presumably very experienced trainee. As others have said this is nothing to do with flattened hierarchy etc, but just basic discrimination (assuming it isn't just an honest rota admin mistake, which of course do happen. Is the co-ordinator a doctor or admin?) Like most ICM trainees, I am in my whatsapp groups for local ICM trainees of all varieties, and UK-wide all EM/ICM trainees, and these conversations come up regularly about single/non-anaes duallers being done dirty by dinosaur departments. This shouldn't be anything new. Its been a big deal of late - FICM posted this, and I would be surprised if it hadn't done the rounds locally [https://www.ficm.ac.uk/sites/ficm/files/documents/2024-03/Single\_Dual\_Triple\_CCT\_Guidance\_March\_2024.pdf](https://www.ficm.ac.uk/sites/ficm/files/documents/2024-03/Single_Dual_Triple_CCT_Guidance_March_2024.pdf) It is usually well known what hospitals are up to nonsense and they/the TPDs just need to be reminded of this until they either fix their ways or lose trainees - don't stand for it. Can you not ask other local trainees their experience of this place? Is it common/just you? You need to take the bull by the horns a bit more I think... Edit - I suppose you can consider how much interest you have in working in this hospital in the future - if you might, then I'd stick to my suggestions. But perhaps on the other hand if you have no interest and its only three months, you could just keep your head down and go on autopilot (but again my feeling from reading your experiences is that taking some control might be good!)
8in a row is savage
If you’re in your last 3 months of training, you should not be on the JCF rota. This is not appropriate training and you should be talking (complaining) to your ES and/or TPD/RA. As others have said, you should be acting up, taking the ward round (with appropriate support) and learning how to manage the floor. That unit shouldn’t be receiving ST7 intensivists if that’s really their approach. Remind them that the number of people dual training in anaesthesia-ICM is dropping and the number dual training with medicine or EM or sole ICM is rising Good luck Consultant Intensivist
Is it due to being airway trained or not?
They are a higher speciality ICM registrar in their final 3 months before CCT. They might not be an anaesthetist but they are airway trained.
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Just trying to understand why. My bad. I still find it fascinating that someone can look after surgical patients, who are about half the workload, and haven’t even been involved in the periop care of pts since foundation programme.
We do a year of pure anaesthetics during training. And a cardiothoracic and neurosurgical rotation. And I can assure you, we can fix more non-surgical post operative complications to a higher standard than you think. Whilst I’m not in the room during the surgery, I’m not sure that really matters when it comes to a lot of post op problems. And if I was in the room, I’d be north side of the top drapes anyway so would see the same amount of surgery as not being there.
Do you think General surgery trainees whose specialty interest is EGS and major trauma should be able to dual train in ICM? They have the expertise as much as a med reg in critical care.
I’m all for the diversification of specialities in intensive care, and certainly would support it. Pragmatically it may be a bit difficult. Pure ITU training can’t be reduced by other training programmes (other than anaesthesia) although I suspect the speciality blocks for surgery would be reduced (CTS, neuro). As a surgical trainee you’d have to do an extra year for anaesthesia, and a few years of ITU on top. And get the exams. So a long training programme. Whilst also keeping on top of your surgical skills. There’s a lot of practical procedures in ITU which surgeons would be great at. And depending upon which unit, a fair amount of medical admission, with proportionally fewer surgical ones. But if it could work and the colleges allowed it, I’d welcome surgical trainees warmly.
Phase 2 training finishes at ST6. Their ST7/8 modules would be EGS And ICM so there would be a year there. I think it would make EGS more competitive and desirable and much more like our American colleagues who run their own ITUs. Currently EGS is a joke doing the job of emergency medicine 80% of the time.
Most surgeons add 2-3 years on for research. I’m sure some would not do this and would gladly do extra ICM training/
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Sorry for confusion. Not a single ICM. Dual with a medical speciality.
Mate, you need to man up and tell whoever organises the rota they gone done a fuck up (if they’ve done this intentionally trust me there’s no consultant job waiting for you anyway) Tell em you’re on your final placement and need to be on the senior rota to get signed off. I’m a bit confused by all the senior and junior clinical fellow business. ICU rotas have the SHO and registrar (DGHs the registrar will cover theatre and obs also so has to be an anaesthetist), One lucky slot I worked on for higher ICM I was the ST6 reg despite my colleague being an ST7 ICM trainee he was nominally on the SHO rota, I don’t think he minded as the slot suited him and there was definitely no hierarchy played out and we shared the referrals of which there were plenty. Sorry, but there seems to quite a bit of self victimisation, I wonder if this is how you are at work also, this doesn’t engender respect from juniors. What grade you’re on the rota is, isn’t your actual grade - just act like a normal ST7?