Dual & Triple CCTs

Curricula and programmes

The Faculty and its partner colleges have undertaken cross-mapping exercises to identify shared competencies that can be dual/triple counted as leading to dual and triple CCTs in ICM and one of the defined partner specialties.

It is important to note that it is the programme which is dual/triple; the trainee is following two/three separate CCT curricula which are combined into a dual/triple programme with mapped capabilties. There is not an individual curriculum for each dual/triple route.

Routes of entry

For dual/triple CCTs, trainees may enter either programme first and have the appropriate capabilties dual/triple counted for the second/third CCT, simultaneous entry to all programmes is not currently possible. Since 2016, doctors are not be able to apply for Dual/Triple CCTs if they are beyond the end of ST5 in their initial specialty of appointment at the time of interview for ICM.

Guidance documents

The guidance below is for dual/triple CCTs undertaken with the CCT in Intensive Care Medicine.

Dual and Triple CCTs with Physician specialties

Following recent approval of the triple CCT principle by the GMC, guidance for triple CCT programmes with ICM and the physician specialties with Internal Medicine have been updated. Please see above for the guidance downloads.

Transition options for current physician trainees training in Intensive Care Medicine (ICM)

The GMC recommends that trainees undertaking dual CCTs with ICM and physician specialties (for ICM-physicians recruited before August 2021) should transition a new curriculum as soon as possible but it is recognised that some learners may require longer to transition based on the impact the new curriculum and transition should take into account feasibility, trainee and patient safety. Where possible, trainees should transfer to the new curriculum, unless in their final year of training.

The new curricula for group 1 physician specialties include learning outcomes for internal medicine and if a trainee has dropped general internal medicine to take up ICM it may not be in the best interest of patient safety or impractical for a trainee to transfer curriculum. A gap analysis should be carried out and to determine whether it is possible for the trainee to transition and if not, postgraduate dean’s approval should be sought for the trainee to complete training on the previous curriculum.

The options for current Acute Internal Medicine/Renal Medicine /Respiratory Medicine trainees who are training in ICM and are not in their final year of training are:

1. Transfer to the new curricula and train in their group 1 specialty (Acute Internal Medicine, Renal Medicine or Respiratory Medicine), Internal Medicine and Intensive Care Medicine. They will be eligible for CCTs in all three specialties.
2. Remain on the previous curriculum if it is not safe or practical for them to also train in internal medicine and CCT in their group 1 specialty and ICM.

Progression in combined training programmes

Updated May 2021

Doctors in ICM dual or triple CCT Programmes take longer to complete their training than they would do if they were training in just one of the specialties. It has come to our attention there is some confusion around establishing the training year for our doctors following a dual CCT programme with a partner specialty.

In counting the years of training, it is agreed that the training years start at admission to the first specialty training programme, and years are added linearly as they are completed irrespective of the responsibility levels reached in the individual specialties, assuming that satisfactory outcomes have been achieved.

The training year at entry (ST3/ST4 etc.) needs to be determined by the Training Programme Director. Due to the different entry routes, trainees may have covered varying amounts of the ICM curriculum prior to appointment, and so would enter at a different point; for example, a doctor from an ACCS core training programme may be appointed at ST4 instead of ST3 level to account for previous experience.

There may be doctors that fall outside of this guidance due to having a complex training history. Where possible, we endeavour to incorporate all relevant prior medical training onto our programme to avoid any unnecessary prolongation of training.

If there are any questions regarding a particular doctor’s training history, we are always happy to help clarify. Please do not hesitate to contact us.

Timing of the FRCA Final examination for dual anaesthetic and ICM doctors in training

In November 2016, the RCoA made provision for anaesthetists in training to progress to higher training (ST5) without having attained the Fellowship of the Royal College of Anaesthetists [FRCA] final examinations, on the basis that they had completed all the mandatory units of intermediate training and would complete the necessary exams within 6 months of commencing ST5.

Such anaesthetists would be awarded an Intermediate Level Progress Report (ILPR) on completion of ST4 and then awarded their Intermediate Level Training Certificate (ILTC) on attainment of the FRCA. This is in effect for all dual anaesthetic and ICM doctors in training who commenced ST3 training from August 2016 onwards. Those who commenced ST3 training in the dual programme prior to August 2016 are not eligible for this process, as this was not agreed by the GMC retrospectively.

Procedure

If a doctor in training has satisfactorily completed all units of stage 1 training, but has not yet attained the FRCA in full:

• They may progress to ST5 and commence their special skills year (higher general anaesthetics)
• They may not commence any of the stage 2 ICM units of training (Cardiac ICM, General ICM, Neuro ICM, Paediatric ICM) until the FRCA is complete
• They should be issued with an Intermediate Level Progress Report (ILPR); the ILPR must be uploaded to the Lifelong Learning platform or e-Portfolio and sent to the RCoA Training Team at the end of ST4.

The ILTC will only be issued once a doctor has satisfactorily completed all intermediate level units of anaesthetic training and attained the FRCA. It is necessary for doctors to upload their ILTC to the Lifelong Learning platform or the e-Portfolio, and send a copy to the RCoA Training team.

Trainees must have passed the Final FRCA examination before progression to remainder of ST5.

If the FRCA final examinations are not passed before mid-way through ST5, approval of additional training time as per the Gold Guide is at the discretion of the ARCP panel on a case-by-case basis.

Currently prospective completion dates are calculated using an indicative period of a further three years from the date of commencement of ST5.