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TRANSCRIPT
Document type: Guide Document category: Training Date established: 2014 Date last reviewed: 2015
College of Intensive Care Medicine of Australia and New Zealand
Guide to CICM Training: Trainees
2
Contents
About this Guide ............................................................................................................. 4
Purpose ....................................................................................................................... 4
Conventions ................................................................................................................. 4
Introduction .................................................................................................................... 5
Welcome to the College of Intensive Care Medicine (CICM) ............................................ 5
Broad Aims of the CICM Training Program ..................................................................... 5
Competencies .............................................................................................................. 6
Overview of the current Training Program ........................................................................ 7
General Intensive Care Medicine ................................................................................... 7
Paediatric Intensive Care Medicine ................................................................................ 8
Training Time .............................................................................................................. 9
Foundation Training (6 months) ................................................................................. 9
Core Training (24 months) ......................................................................................... 9
Transition Training (12 months) ................................................................................. 9
Anaesthesia (12 months) ........................................................................................... 9
Medicine (12 months) ................................................................................................ 9
Elective Training (6 months) .................................................................................... 10
Required clinical experience during training .................................................................... 10
Intensive Care sub specialties ..................................................................................... 10
Paediatric experience ................................................................................................. 10
Rural Experience ........................................................................................................ 10
Overview of Pre-2014 Training Program ......................................................................... 11
General Intensive Care Medicine ................................................................................. 11
Paediatric Intensive Care Medicine .............................................................................. 11
Training Time ............................................................................................................ 12
Basic Training Years (36 months) ............................................................................. 12
Advanced Training Years (36 months) ...................................................................... 12
Anaesthesia (12 months) ......................................................................................... 12
Medicine (12 months) .............................................................................................. 12
Elective Training (up to 12 months) ......................................................................... 12
Important information for all trainees ............................................................................. 13
Approval of Training ................................................................................................... 13
Recognition of Prior Learning ...................................................................................... 13
Interrupted Training ................................................................................................... 13
Overseas Training Experience ..................................................................................... 13
Part-Time Training ..................................................................................................... 13
Research ................................................................................................................... 13
3
Assessment Processes and Requirements ....................................................................... 14
Examinations ............................................................................................................. 14
The First Part Examination ....................................................................................... 14
Exemption for the First Part Examination .................................................................. 15
The Second Part Examination (General and Paediatric) .............................................. 15
Workplace Based Assessment (WBA) .............................................................................. 16
Objectives ................................................................................................................. 16
Online In-Training Evaluation Report (ITER) ................................................................ 16
Formative Self-Assessment by Trainees .................................................................... 16
Workplace Competency Assessment (WCA) ................................................................. 17
Observed Clinical Encounter (OCE) .............................................................................. 17
Courses ........................................................................................................................ 18
Formal Project .............................................................................................................. 19
How do I get the most out of the Training Program? ....................................................... 20
Characteristics of Successful Learners in the Clinical Environment ................................. 20
Willingness ................................................................................................................ 20
Professionalism .......................................................................................................... 20
Personal Attributes ..................................................................................................... 21
Communication and Interaction .................................................................................. 21
Knowledge, Understanding and Skills .......................................................................... 21
Characteristics that Differentiate Successful from Unsuccessful Students ....................... 22
Giving and Receiving Feedback ...................................................................................... 23
Tips for Receiving Feedback ........................................................................................ 24
Tips for Giving Effective Feedback ............................................................................... 25
Trainee Welfare and Support ......................................................................................... 26
Overview ................................................................................................................... 26
Professional ............................................................................................................... 26
Academic ................................................................................................................... 26
Administrative ............................................................................................................ 26
Career ....................................................................................................................... 26
Personal .................................................................................................................... 26
Family Needs ............................................................................................................. 27
Illness and disability ................................................................................................... 27
Experiencing Difficulties during Training ...................................................................... 27
Difficulties with Examinations ................................................................................... 28
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5
Introduction
Welcome to the College of Intensive Care Medicine (CICM) As a trainee of the CICM you have elected to participate in a demanding and rigorous training program. Success in your training and assessment requirements will allow you to graduate as a Fellow of the College of Intensive Care Medicine (FCICM). Before this can occur there is a great deal for you to achieve. While you will receive lots of support, and have access to a number of excellent resources, the responsibility for your learning rests with you. You are encouraged to make use of all the training and educational opportunities that are available.
Broad Aims of the CICM Training Program During your time as a trainee you will: 1. Acquire such knowledge, problem solving ability, practical skills and attitudes
appropriate for the safe and effective practice of intensive care medicine. This extends to patients, equipment and the intensive care environment.
2. Develop the ability to respond rapidly and appropriately to life threatening problems
and establish the priorities of management. 3. Be able to act appropriately as a member or leader of a team. 4. Acquire knowledge in those aspects of medicine, surgery, paediatrics, obstetrics,
anaesthesia and other disciplines, which are relevant to the practice of intensive care medicine.
5. Develop the ethic that the patient's welfare always takes precedence in the event of
medical, political or ethical conflicts. 6. Provide patients with the best possible care considering available resources. 7. Learn to identify and modify the stresses which the intensive care environment places
upon the patients, their relatives and hospital staff. 8. Participate in the processes of clinical audit and quality improvement activities. 9. Enquire into clinical and scientific problems, adopting systematic and critical appraisal
of available information. 10. Contribute to the education of medical, nursing and paramedical staff. 11. Develop a process of regular self-assessment so that limitations can be identified and
deficiencies corrected. 12. Be aware of current College policies on professional issues and act in ways consistent
with these policies.
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20
How do I get the most out of the Training Program? Factors underpinning successful learning for trainees
Characteristics of Successful Learners in the Clinical Environment In the clinical setting successful learning depends on a collaborative relationship between the trainee and their educators. The onus for creating effective and successful relationships during clinical learning is the responsibility of both the trainee and supervisors. From the literature of health professional education a range of characteristics required for successful learning have been identified. It is important to note that the key characteristics are not possession of adequate knowledge, skills or understanding but rather a willingness to learn, seek out feedback and learning opportunities, complete tasks, effective communication and interaction with others and taking responsibility for learning. In order of priority the characteristics and associated behaviours are as follows:
Willingness Trainee is willing to:
seek and act on feedback
work as a team member with peers, colleagues and other health professionals
ask questions and clarify to ensure understanding
try new techniques
discuss and exchange ideas to maximise patient care
complete all tasks requested of them
take responsibility for their own learning
self-reflect and evaluate
Professionalism The trainee:
respectfully engages with people from a wide range of cultures and backgrounds
is prepared to learn
maintains an appropriate appearance, is punctual, and has a clear understanding of their role
complies with professional matters such as confidentiality, ethical and legal requirements
maintains appropriate professional boundaries
has a self-awareness of own limitations and is honest about their current level of knowledge and skills
21
Personal Attributes The trainee:
has an internal locus of control (i.e. they believe that events in their life derive primarily from their own actions rather than blaming external factors)
demonstrates enthusiasm and interest in their work
is able to manage stress levels
demonstrates a desire to learn
is polite, helpful, self-directed, proactive, curious and asks questions
is sensitive and empathetic to patient and family’s needs and concerns Communication and Interaction The trainee:
communicates professionally with members of the health team
demonstrates respectful and non-judgemental communication
demonstrates effective written and verbal communication skills
appreciates non-verbal communication
has the capacity to adjust their communication style to meet the needs of the audience be they colleagues, patients, or others
Knowledge, Understanding and Skills The trainee:
demonstrates basic knowledge relevant to clinical area (including basic sciences and key features of common conditions)
is able to accesses information when a gap in knowledge or need for further knowledge is identified
is able to access and apply knowledge to clinical situations
demonstrates effective organisational skills
demonstrates effective problem solving skills (Chipchase et al 2012)
22
Characteristics that Differentiate Successful from Unsuccessful Students Looking at successful and unsuccessful students together, three categories describing these two types of students seemed to be opposites of each other: communication, preparation, and functioning in the clinical area. Communication. Successful students could build relationships and communicate with faculty, staff, patients, and peers. Unsuccessful students had difficulty communicating with patients, faculty, peers, and clinical staff. Preparation for the Clinical Experience and Use of Feedback. Successful students were prepared for the clinical experience. They showed progress, accepted feedback, and adapted easily in the clinical experience. Unsuccessful students were not prepared and did not show improvement. Functioning in the Clinical Area. Successful students could think critically, integrating theory into clinical experiences, developing a plan of care for patients, and providing safe care. Unsuccessful students could not function in the fast-paced clinical environment. Successful students had a positive attitude with an eagerness to learn. Unsuccessful students jeopardized patient safety, committed legal-ethical violations and their attitudes to learning were often criticised by their supervisors. (Chipchase et al 2012; Lewallen and DeBrew 2012)
23
Giving and Receiving Feedback
Since feedback is the key component to learning and changing performance, it is appropriate to understand how to effectively give and receive feedback. Effective feedback answers 3 questions:
1. Where am I going? (the goals) FEED UP
2. How am I going? FEED BACK
3. Where to next? FEED FORWARD When you receive feedback, be prepared that it is often uncomfortable but if you proactively engage in the process the outcome will be positive. “If learners are provided with information that they have to wrestle with, reflect on, experiment with, this can act as a potent stimulus for learning and for reconsidering new ways of knowing and doing” (Molloy, Borrell-Carrió, Epstein 2013 p. 51)
24
Tips for Receiving Feedback Listen candidly: This means not interrupting. Hear the person out, and listen to what they are really saying, not what you assume they are going say. You can absorb more information if you are concentrating on listening and understanding than if you are being defensive and focusing on your response. Be open: This means being receptive to new ideas and different opinions. Often, there is more than one way of doing something, and other people may have a completely different viewpoint on a topic. Remain open, and you may learn something worthwhile. You don’t have to believe it or act on it, but you must listen openly. Be aware of your non-verbal responses: Your body language and tone of voice can speak louder than words. Looking distracted and bored sends a negative message and can create unnecessary barriers. Attentiveness, on the other hand, indicates that you value what someone has to say, and puts both of you at ease. Know what you want: Alert your feedback sources (your SOT and others) to the specific feedback you want. Place clear boundaries around the feedback: Let people know what you want and how much feedback you want to hear at one time. If you fail to define precisely what you want, you run the risk of hearing too much. Once that happens, it’s easy to get defensive. Clarify detail and ask for specifics: Ask questions to make sure you understand. “I’d like to understand what behaviours you saw so that I can better understand what to do differently next time.” Be accepting: Accept the impact of your behaviour as reality for the other person. You don’t have to agree with it. Focus on the future: Ask for specific advice on what to do differently and what to repeat going forward. Agree on an action plan. Reflect and decide what to do: Take time to reflect on the feedback and consider the consequences of using it or ignoring it, and then decide what you want to do. Follow up: There are many ways to follow up on feedback. Sometimes, your follow-up will simply be to implement the suggestions you‘ve been given. In other situations, you might want to set up another meeting to discuss the feedback or to request your supervisor to review your performance in another similar situation. Ask for feedback early and often: Giving effective feedback takes time and isn’t often at the front of people’s minds. We know that it’s easier to respond to feedback early when you have an opportunity to change something. As the person receiving feedback, it often helps to invite people to give you feedback as this alleviates the fear most people have when giving feedback.
25
Tips for Giving Effective Feedback 1. Invite the person you are giving feedback to, to self-evaluate (may need further probing-
ask for examples)
2. Emphasise decisions and actions rather than assumed intentions
3. Ask learners to summarise key points
4. Clarify or check for shared interpretation of content
5. Encourage learners to record key points gained from the session
6. Be specific: Avoid general comments that may be of limited use to the receiver. Include specific examples to illustrate your statements
7. Be realistic: Feedback should focus on behaviours that can be changed
8. Be timely: Find an appropriate time to communicate your feedback. Being prompt is key
because feedback loses its impact if it is delayed too long
9. Negotiate when and where feedback will be discussed
10. Own the feedback: When offering evaluative comments, use the pronoun “I” rather than “they” or “one”, which would imply that your opinion is universally agreed on. Remember that the feedback you provide is merely your opinion
11. Offer continuing support: Feedback should be a continuous process, not a one-time
event. After offering feedback, make a conscious effort to follow up
26
Trainee Welfare and Support Overview Training, like many aspects of life, can be exciting and rewarding, but also has its ups and downs. As a trainee you are exposed to numerous sources of stress similar to those encountered by all students. This includes formal assessments, time management issues, information overload, paucity of time for personal relationships and/or recreation, financial and career concerns. Moreover you are also exposed to sources of stress not common to non-medical professionals. These include death and dying, relating to other health professionals and the potential fatal consequences of making a mistake. This is a fertile environment for the generation of problems as well as learning and positive experiences. Problems encountered by trainees typically fall into one of five types; professional, academic, administrative, career and personal.
Professional Some trainees encounter problems with professional or ethical conduct. To be effective, an intensive care specialist must be able to interrelate successfully with medical staff and colleagues. Patients increasingly and appropriately demand to be treated politely and with consideration. They also expect medical practitioners to be honest, trustworthy and empathic. As a trainee you may require support in these areas. This support may need to extend to professional counselling to enable you to develop appropriate attitudes and conduct yourself in a professional manner. This is particularly true for trainees who are unaware of personal limitations or who have a limited capacity for self-audit. Identification and correction of a problem in this area is of paramount importance as the majority of medico-legal problems have communication difficulties as a basic cause.
Academic This is perhaps the most obvious problem area for trainees. The academic challenge of the CICM Fellowship is high and you are encouraged to seek out avenues of support. You can seek out advice and feedback on exam preparation, study skills, time management and elective periods of study even though you may have addressed these issues during your medical course. It is important for you to realise that no single individual is ideally placed to undertake all the above and thus it is important to identify suitable personnel to assist in these areas.
Administrative Trainees often encounter problems of a “when”, “who”, “where”, “what” or “how” nature relating to the administrative aspects of their department, hospital or College. Although these questions may seem trivial to non-trainees they are often the cause of considerable unnecessary angst. Fortunately they are also among those most easy to address and the supervisor should be consulted in the first instance.
Career The wise trainee will seek guidance about their career path. Supervisors, Head of Department, other Specialist Intensivists and trainees are potentially useful sources of career information.
Personal Personal problems can have an enormous impact on your overall performance during your clinical rotations. Relationship difficulties, financial worries, accommodation concerns and interpersonal conflicts are just some of the many problems that may arise. These problems must also be dealt with urgently in a sensitive and confidential manner. You are encouraged to seek assistance with these (and all) problems from supervisors and other appropriate personnel.
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