Training for doctors

Welcome to the education page for the Intensive Care Unit at Great Ormond Street Hospital. These units are divided into paediatric, neonatal and cardiac intensive care areas. In addition, trainees rotate to the Children’s Acute Transport Service (CATS).
This is a large, dynamic and busy unit and there is a wealth of learning opportunities. We expect trainees to participate fully in the day to day running of the unit and in the extensive teaching programme. Our belief is that in doing this, trainees will get most out of their time with us.

Across the unit there are individuals who have responsibility for different areas of training. These change on a regular basis. Download a current list of who's who in ICU training

• Educational supervisors & nurse buddy list : PICU/NICU, CCC, CATS
• 360 degree appraisal
• Monthly core teaching sessions
• WEBEX system instructions (Word document, 789 KB)
• GOSH Monthly training programme (Excel document, 475 KB)
• Regular clinical meetings
• Joint subspecialty meetings (PDF, 5 KB)
• Royal College of Anaesthetists web-based learning
• CATS website
• PIC medicine fellowship programme - on the PageTiger platform.

Each SpR has an educational supervisor for the duration of their post, and a clinical supervisor in EACH intensive care area he or she rotates to. Each SpR is also allocated a senior nurse mentor on P/NICU and CICU, appointed prior to your ICU start date.

All trainees should have a series of appraisals throughout their time with GOSH regardless of whether they are in a Deanery training post or a Trust post. Appraisal is concerned with setting personal goals. It reviews personal, educational and job related achievements, is confidential, pastoral and designed to assist an individual to progress. It is your responsibility to contact your educational supervisor and make an appointment for the initial appraisal meeting and to jointly set dates for subsequent meetings.

You should meet your educational supervisor for the particular area (e.g. CICU, CATS, P/NICU) in the first one to two weeks of the attachment to identify appropriate educational goals and plan. You should then meet at three months or midpoint for appraisal of objectives, and then at six months or in the last month of your post to complete the appraisal process and review training. The meetings will be recorded and once agreed will be stored on a central database which will be accessible to all supervisors in your time on ICU. This will allow for continuity of educational appraisal between units while you are with us.

In addition, a  will be taken in each unit of a rotation. This is a multi-source appraisal process whereby each trainee is assessed by a consultant (who is not their clinical supervisor), a sister or charge nurse and a fellow registrar. Each assessor is randomly picked by the co-ordinator and is anonymous. The information is then collated and discussed with the educational supervisor at the next appraisal meeting.

There is a well developed ICU modular training programme which is based on the ICTPICM (Intercollegiate Committee for Training in Paediatric Intensive Care Medicine) syllabus and is entirely comparable with the Australian and North American syllabi making it useful for overseas trainees also.
The modules are listed below:

1.  Monitoring in the ITU
2.  CATS - Resuscitation and Emergency Management
3.  Cardiovascular Physiology and Cardiopulmonary Interactions
4.  Respiratory Physiology
5.  Psychosocial Aspects of ITU
6.  Principles of Mechanical Ventilation
7.  Ventilation Strategies for Specific Conditions
8.  Arrhythmias and Cardiovascular Pharmacology
9.  Pharmacy and Drug Toxicity
10.  Sedation, Analgesia, Neuromuscular Blockade
11.  Anaesthesia in Children & Infants
12.  Airway Management
13.  ENT on PICU
14.  Management of the Cardiac Pre- and Post-Operative Patient
15.  Clinical Governance and Risk Management
16.  Congenital Anomalies Requiring Surgery
17.  Surgical Neonates
18.  CVS and ICU Management - Shunt Lesions
19.  Medical Neonates
20.  Basic Immunology
21.  Shock
22.  SIRS, Sepsis and MODS
23. CVS and ICU Management - HLHS and Single Ventricle Physiology
24.  Haematology and Transfusion
25.  Immunology & Oncology
26.  Renal Physiology and Pathophysiology
27.  Renal Replacement Therapy
28.  Genetics in ITU

On the last Wednesday of each month there is a ‘Core Curriculum Teaching Day’. These are held jointly with other North Thames intensive care units, St Mary’s Hospital (SMH), Royal Brompton Hospital (RBH) and the Children’s Acute Transport Service (CATS). These are one-day programmes which comprise a series of lectures on a chosen topic and are held at one of the four sites. 
For each chosen topic, the organised lectures will aim to cover subjects listed in the ICTPICM syllabus in a programme of structured teaching. Attendance at these teaching days is mandatory and is monitored. It is recognised that attendance is not always possible especially at another site to your base hospital. We are currently in the process of recording these presentations in real time on the WEBEX system. These can then be watched at any time by following the WEBEX system instructions.

Study leave has been built into the full shift rotas on ICU. The rotas have been devised so that the majority of study leave days fall on a Wednesday.
The ICU training programme runs across all units: P/NICU, CICU and CATS. It runs throughout the week with particular emphasis on Wednesday to coincide with the study leave days. Attendance at teaching sessions on these days is MANDATORY. A register will be taken and record of attendance sent to your educational supervisor.
Every attempt will be made to facilitate trainees on shift to unit teaching sessions. If you wish to attend an ICU teaching session when you are on shift, please ask the consultant on call to assist you with this.
Download an up-to-date unit training programme (Excel document, 475 KB).
These sessions only succeed with FULL trainee participation. You may be asked to present at one of the following:

• ICU Mortality and Morbidity Meetings (M&M). Paula Smith (Medical PA, ext 8213) will tell you the cases for the M&M meetings and get the notes for you.
• Journal Clubs. You can choose any paper to present at journal club.
• Joint ECMO M&M
• Case-Based discussions where you present a case of your choice that we managed on ICU and discuss the evidence base for management. This is assessed according to the RCPCH proforma by 2 of the ICU consultants and a copy is kept in your file.
• R&D meetings on the 3rd (and sometimes 4th) Tuesdays of each month, presenting the research or audit projects that you have in progress.
• Joint ICU meetings

There are weekly clinical meetings with other medical teams about current ITU patients and take place on the ICU. It is the duty of the day staff to attend, present relevant patient information and to document any discussion outcomes in the notes. These are valuable learning opportunities. Download a programme of current clinical meetings.

We have joint subspecialty meetings (PDF, 5 KB) with other medical teams at varying intervals which usually take the form of interesting M&M discussions; you may be asked to present a recent patient. Some occur regularly and others on an ad hoc basis. They are great learning opportunities so please make every effort to attend. The dates for these meetings are flexible as we are dependent on the availability of other specialities.

For those non-anaesthetists amongst us, although a period of dedicated anaesthetics training is the gold standard, it is difficult to achieve.
We have close links with the anaesthetics department; some trainees will come from an anaesthetics background and some will be rotating through the year-long anaesthetics fellowship programme with a three month ICU attachment. Please make use of your colleagues as a valuable source for learning; we have a great wealth of backgrounds and it makes for diverse set of skills.
More formal anaesthetic training is offered to those from a paediatric background in the form of a one week attachment to theatres where you have the opportunity to practice practical skills and learn about anaesthetic technique. Carol Parkes will automatically assign you a week. Please liaise with her regarding this.
You also have access to the Royal College of Anaesthetists web-based learning. You will need to register before being able to access the modular training program. Instructions on how to do this will be given to you at your ICU induction day.

This online campus can be accessed at http://www.goshgold.org.
There are five mandatory courses which must be done within one month of your induction. These are: 

• Safeguarding children
• Fire
• Major Incident Plan
• Caring For neonates

• Diversity and equality

• Good Research Practice

More training information is available on the CATS website.
Procedural training videos have been produced by many units around the world. The following training videos are available to staff on the unit:

• IJ central venous line
• Male urethral catheterisation
• Arterial lines
• BMV
• Chest drain insertion
• Cricothyroidectomy
• Examination larynx & pharynx
• Female urethral catheterisation
• Femoral CVL
• Intubation
• Lumbar puncture
• NG tube insertion
• Paracentesis
• Peripheral venous cannulation
• Subclavian CVL
• UAC & UVC