Intensive Care Medicine

[heed]

Hey guys - interested in a career in ITU. Would probably go into it from an anaesthetics background. question is - would you recommend training in the acute care common stem or the anaesthetics stem? I know now its much easier for MRCP/FFAEM people to go into ITU aswell, but is the FRCA route still seen as the better option??

any advice would be great!

[dehydrated water]

hey Andrew, hope you're well....

from what i gathered from my SSM, all the guys working in the ITU were anaesthetists, they all work on a rota, and do a fair amount of normal anaesthetic stuff too (i'm talking about the consultants here). as for trainees in ICU, they were all doing their FRCA stuff, so i guess the FRCA stem for that hosp.

from what i gathered (don't quote me) most of the UK hospitals have an ICU team ran by anaesthetists with a special interest, whereas places like the USA tend to have anaesthetists and intensivists as seperate specialities.

[heed]

yeah i did an SSM in ITU this year and everyone there certainly was from an anaesthetics background with both an ITU commitment and an anaesthetics commitment. You're right about the intensivist thing - in Oz certainly you have to pick ordinary anaesthetics OR intensive care anaesthetics.

the thing about the ACCS versus Anaesthetics stem is that you get to do your FRCA in both of them - its just that if you come from the acute care stem you get a dual CCT in Anaesthetics and ITU - whereas im not sure its the same thing for the anaesthetics stem. meh.

i have confused myself already - im going to stop before my brain hurts.

any anaesthetists kicking about on here? help!?

[andy2]

ITU in the UK is overwhelmingly staffed by anaesthetists (>80%). As of yet there is no separate 'intensivist' training scheme so one requires a base specialty (Medicine, Emergency Medicine, Anaesthetics or Surgery) -however the Intercollegiate Board for Training in Intensive Care Medicine (ICM) are considering a stand alone training scheme which would last for 7 years, starting with ACCS and then with a further five years of ICM, medicine, surgery and anaesthetics but this has not been confirmed yet.

As to routes into ICM - due to the requirement to have completed six months of medicine, it is likely that most Anaesthetists doing higher training in ICM will have come through the ACCS route. ACCS gives several advantages - firstly it gives one experience of Medicine and Emergency Medicine, second it provides enough medical experience to sit the MRCP (if you want to, not obligatory even for aspirant intensivists) and it adds an extra year's training so making one more experienced when applying for consultant jobs. Although those entering straight into Anaesthetics may be able to pick up the medical experience required for higher training in ICM, this is not certain.

It may be that Anaesthetic training will change in a couple of years time and that all anaesthetists will complete ACCS before embarking on Anaesthetics - so keep your ear to the ground. For now, however, I would plan on applying via the ACCS route.

(the other advantage is that one could also change to another acute specialty if it turns out that ICM/anaesthetics is not for you - of 6 of us who started a proto-type ACCS in 2004 5 of us changed from our original career intentions, one swopping from EM to Anaesthesia, two from Acute Medicine to Anaesthesia, one from Anaesthesia to EM and one from anaesthesia to Acute Medicine).

[Hal100]

Can somebody tell me what a consultant in intensive care medicine might likely do?
Is it more exciting than the notorious newspaper-reading, sudoku-playing role that many anaesthetists seem to have in your average operation?!
I'm presuming most of the shop-floor kinda work in an ICU is done by junior docs and nurses/nurse practitioners?

[belis]

I did a month placment on ICU. The arregments were that consultant would do a round in the morning adjusting treatment plans, looking at results, examining patients, delegating what needs to be done etc. Then they would either depart somewhere for the rest of the day, teach juniors or get involved with tasks on hand. Depends on consultant and their mood that given day. They would usually pop back a couple of times during the course of the day to make sure things are not getting out of hand or to help with new admissions.

ITU is not always overly exciting. There are ofcourse times when you need to make quick decision and interventions but a lot of the things are routine. It is all about planing and paying close attention to details so that you can intervene early and hopefully avoid any hair-raising emergencies.

[andy2]

I would be cautious of dismissing anaesthethesia as simply turning on the gas and then sitting down to do the crossword whilst the surgeon does all the tricky stuff :-( It is only once you start giving anaesthetics that you realise the true challenge of it.

Anyway back to the question - what do consultant intensivists do? The usual day would be something like this:
8-9am meet with consultant who was on overnight and take hand-over of the patients. Review any patients who required immediate attention and check if there had been any referrals from wards.
9-11 Each patient is individually reviewed, either by a junior doctor or the consultant.
11-13 Ward round - led by the consultant, all patient reviews are discussed, treatment decisions made for the day, results reviewed and investigations or procedures planned.
13-16 Investigations and procedures undertaken - these may be done by the consultant themselves or they may supervise and teach junior members of staff - examples include bronchoscopy, insertion of invasive monitoring lines, tracheostomys etc....
16-17 Hand over to consultant who is on-call for the evening/night time.

Because of the nature of ITU, this routine may well be interrupted by a referral from the wards, A+E or theatre which can result in admission to the unit - additionally patients in the unit may become suddenly unwell and require emergency interventions. Then there are administrative duties, the need to keep up to date with developments in the field, teaching commitments, formal supervision of juniors etc... so there is plenty to occupy the time of a consultant in Intensive Care Medicine. Some days there is little more to do than tinker with the medications and therapies of the patients, with slow or little progress - other days it is urgent call after urgent call and little time to sit down and think let alone worry about having time on your hands.

[benneh]

pardon my ignorance but im unsure of what ITU is. ICU means intensive care unit, and from google i think ITU is intensive therapy unit?

can anyone explain the difference for me?

thanks alot

[belis]

There is no difference. It is just semantics. The running joke is that we do not call it ICU as we had stopped carying long ago.