ICM is the only UK specialty where the Portfolio Pathway assessment body is a Faculty (FICM) rather than a Royal College. That changes how applications are assessed, what knowledge evidence is required, and what structured reports must contain. On top of those structural differences, ICM has its own unique curriculum requirements - 14 HiLLOs, a mandatory Special Skills Year, and evidence from at least five separate specialty contexts - that make it one of the most evidence-intensive specialties on the Portfolio Pathway route.
Why ICM is structured differently from every other specialty
If you have read the Portfolio Pathway overview or the SSG guide, you will know the general shape of the process: assemble evidence against the GMC four domains, get it assessed by the relevant Royal College or Faculty, and if it passes, the GMC adds you to the Specialist Register. For the vast majority of specialties, the assessment body is a Royal College - the RCP, RCSEd, RCoA, RCPath, or one of the others.
ICM is different. The Faculty of Intensive Care Medicine, which holds the ICM CCT curriculum and runs the FFICM examination, is an independent Faculty rather than a Royal College. It was established as a joint Faculty of the Royal College of Anaesthetists and the Royal College of Physicians in 2010 and became fully independent in 2017. For Portfolio Pathway purposes, it functions as the specialist assessment body for ICM in the same way a Royal College would - but its institutional form is a Faculty, and that distinction has practical consequences.
Those consequences include: how FICM's assessors approach applications, the specific requirements set out in the ICM Specialty Specific Guidance, and the fact that ICM applicants who are also seeking anaesthetic registration must navigate two completely separate processes through two completely separate bodies. There is no combined or fast-track route for dual-trained doctors.
Beyond the institutional structure, ICM has curriculum requirements that no other specialty carries in quite the same combination. The 2021 ICM CCT curriculum sets out 14 High-Level Learning Outcomes. It mandates a Special Skills Year. It requires evidence from placements in at least five clinical contexts beyond standard general ICU. And the structured report requirement includes a specific Clinical Director report that is more prescriptive than the equivalent in most other specialties. Each of these elements needs its own evidence strategy, and together they make an ICM Portfolio Pathway application one of the most complex to assemble correctly.
The ICM Portfolio Pathway complete guide covers the application structure, curriculum framework, and timeline. This article goes deeper into the specific features that make ICM unique - the ones where generic Portfolio Pathway advice breaks down and you need to understand ICM's particular requirements rather than the standard model.
FICM as Faculty and assessment body
Understanding FICM's dual role is the starting point for understanding every other aspect of ICM Portfolio Pathway. FICM is simultaneously the body that owns the ICM CCT curriculum, the body that administers the FFICM Fellowship examination, and the body that assesses Portfolio Pathway applications. In most specialties these functions are distributed: the curriculum may be owned by a faculty or college, the examination is a separate product, and portfolio assessment is a specialist function within the college. For ICM, all three sit within FICM.
- ICM CCT curriculum 2021
- 14 High-Level Learning Outcomes
- Special Skills Year requirements
- Stage structure and signoff criteria
- Specialty Specific Guidance for Portfolio Pathway
- FFICM Fellowship examination
- Primary and Final FFICM components
- DICM Diploma
- Recognition of comparable qualifications (EDIC, FCICM)
- Test of knowledge domain for the SSG
- Portfolio Pathway application assessment
- Assessor panel drawn from senior FICM fellows
- Correspondence with applicants on deficiencies
- Recommendation to GMC on specialist registration
- Liaison with GMC on borderline cases
Key implication for applicants: because FICM assesses against its own curriculum using its own examiners, the standard of evidence expected is set internally by people who also write and mark the FFICM. The bar is calibrated to CCT-level practice, not to an independent external standard.
The practical consequence of this arrangement for a Portfolio Pathway applicant is that the assessment process is highly curriculum-specific. Assessors are working from the ICM CCT curriculum and the ICM SSG simultaneously, and they are likely to be familiar with both documents in detail. Generic evidence statements that do not map to the HiLLOs, or that use language from a different specialty's curriculum, stand out immediately. The application needs to speak the language of ICM - the specific terms the FICM curriculum uses for stages, outcomes, and competencies.
FICM also maintains its own post-submission process that can include requests for additional evidence or clarification. Because FICM has the curriculum expertise in-house, these requests tend to be specific: not "provide more clinical evidence" but "provide evidence mapped to HiLLO 7 from Stage 2 of the General ICM curriculum, including SLEs from at least two assessors." That level of specificity is a feature, not a complication - it tells you exactly what is missing. But it means the initial application needs to be structured around the HiLLOs from the outset, not retrospectively mapped to them after a deferral request arrives.
The 14 HiLLOs: the architecture of ICM evidence
The ICM CCT curriculum 2021 is outcomes-based. Its 14 High-Level Learning Outcomes (HiLLOs) are the framework against which all evidence is measured - in CCT training, in Capabilities in Practice assessments, and in the Portfolio Pathway. The first four HiLLOs are generic, shared with other specialties assessed by the GMC four-domain framework. The remaining ten are specific to ICM or to the complementary specialties ICM trainees rotate through.
The practical implication of this 14-HiLLO structure is that an ICM Portfolio Pathway application cannot be assembled from a single evidence pool. Each HiLLO needs dedicated material. HiLLOs 1 to 4 map to the GMC four domains and can draw on standard evidence types - MSF, appraisals, audit, teaching logs, and management roles. HiLLOs 5 to 14 need specialty-specific and placement-specific evidence that can only come from practice in the relevant clinical settings.
Mapping evidence to HiLLOs before you start assembling the application is not optional - it is the only way to identify gaps early enough to fill them. A gap in HiLLO 10 (Paediatric ICU) that appears in a deferral letter eighteen months before you intended to submit requires a planned PICU placement that many non-training-grade ICU doctors will not have arranged in advance. Identifying that gap two years earlier means you can build it into your job plan rather than having to negotiate a temporary secondment at short notice.
FFICM, EDIC, DICM, and FCICM: the knowledge evidence question
ICM Portfolio Pathway has an important principle embedded in the FICM guidance: there is no specialist medical qualification that gives automatic entry to the Specialist Register in ICM. This is different from some other specialties where holding the relevant Fellowship examination is a near-sufficient condition for knowledge domain evidence. In ICM, even FFICM holders need to demonstrate knowledge across the curriculum through their application; the exam is evidence of knowledge, not a shortcut around the rest of the process.
That said, holding FFICM, or a recognised equivalent, substantially strengthens the knowledge domain of an ICM Portfolio Pathway application. FICM recognises the EDIC (European Diploma in Intensive Care Medicine, awarded by the European Society of Intensive Care Medicine), the DICM (Diploma in Intensive Care Medicine, awarded by FICM itself for doctors from a non-CCT background), and in some circumstances the FCICM (Fellow of the College of Intensive Care Medicine of Australia and New Zealand). Whether a specific qualification is accepted and how it is weighted is a matter for the current FICM Portfolio Pathway guidance and the assessors at the time of application; always check the current FICM documentation rather than relying on historical accounts of what was accepted in previous application cycles.
Applicants who hold none of these qualifications face a more demanding knowledge domain. They need to demonstrate knowledge equivalent to FFICM-level through a combination of: personal study records and CPD logs mapped to the curriculum, case-based evidence of clinical reasoning at Consultant level, SLE and CbD evidence where the clinical discussion demonstrates curriculum breadth, and written reflective entries on cases that span the HiLLOs. This is achievable but it requires conscious construction of the knowledge domain from the outset rather than relying on the examination record to carry that part of the application.
If you do not hold FFICM and are planning a Portfolio Pathway application in the next two to three years, the most cost-effective investment may be sitting EDIC (if you are eligible through ESICM) rather than attempting to build an equivalent knowledge base from CPD logs alone. EDIC is specifically named in FICM guidance as an accepted comparable qualification and is widely available to experienced ICU clinicians. Discuss the current position on DICM directly with FICM if you are considering that route - the DICM was designed partly for this applicant cohort.
The Special Skills Year: ICM's unique curriculum requirement
The Special Skills Year is a mandatory component of the ICM CCT curriculum with no equivalent in any other specialty. Trainees on the ICM training programme complete a full year of advanced study and practice in an area related to ICM. Portfolio Pathway applicants must demonstrate that they have met the SSY curriculum requirements in their chosen area, whether through a formal year-long placement or through sustained experience built up over a longer period in the same area of advanced practice.
Neuro Intensive Care
Subarachnoid haemorrhage, traumatic brain injury, status epilepticus management, ICP monitoring, and neurosurgical ICU support. Most commonly evidenced from a placement at a neurosurgical or specialist neuro ICU centre.
Cardiothoracic ICM
Post-cardiac surgery care, ventricular assist device management, ECMO, and cardiac transplant ICU. Requires access to a cardiothoracic surgery centre with a specialist CTICU.
Paediatric ICM
Critical illness in children, paediatric-specific physiology and pharmacology, PICU transfers, and family-centred care. Requires PICU placement at a centre with a designated PICU service.
Research / Academic
Clinical research in the ICU environment, trial participation, grant activity, and peer-reviewed publications. Often combined with an honorary academic attachment or an NHS research fellowship.
Pre-hospital / Retrieval
HEMS, MERIT team, or retrieval service experience at Consultant level. Requires specific exposure to pre-hospital critical care or specialist retrieval operations.
Trauma and Burns
Major trauma ICU, burns centre ICU, or a combination of major trauma and burns experience to the standard set by the FICM SSY curriculum for this area.
Evidence approach: the SSY evidence must map explicitly to the SSY curriculum for the chosen area - not to the general ICM curriculum. FICM publishes individual SSY curricula. Applicants who have been practising in their chosen SSY area for years but have never formally documented it against the SSY curriculum often find this the most labour-intensive part of assembling the application retrospectively.
The most common SSY-related problem in Portfolio Pathway applications is a mismatch between what the applicant has done and what the SSY curriculum for their chosen area actually requires. A doctor who has managed many patients with subarachnoid haemorrhage on a general neuroscience unit may have substantial neuro ICU experience, but the SSY curriculum for Neuro ICM requires specific competencies - ICP monitoring interpretation, decompressive craniectomy care, targeted temperature management protocols - that may not all be represented in the evidence even if the clinical experience is genuinely there.
FICM notes in its Portfolio Pathway guidance that applicants who do not already hold SSY sign-off may need up to twelve months to meet the SSY requirements before they are ready to submit. This is not a bureaucratic obstacle but a genuine curriculum requirement. If the SSY component is not complete, the application cannot demonstrate the full ICM CCT curriculum, and it will be deferred.
Multi-specialty placement evidence: what the SSG demands
The ICM SSG is explicit that evidence must come from multiple clinical environments, not only from general ICU. This is another feature of ICM that has no clear parallel in other clinical specialties (as opposed to pathology specialties, which also require laboratory and clinical side evidence). An ICM applicant who has worked exclusively in a large general ICU, even at Consultant level, cannot demonstrate the full curriculum without evidence from the complementary specialty contexts.
ICM Portfolio Pathway: evidence by specialty context
ICM SSG requirement| Specialty context | Key evidence required | Status |
|---|---|---|
| General ICM | Core organ support, multi-organ failure, sepsis management, SLEs from ICU, procedural competence, on-call evidence, Consultant-level clinical decision-making | Core requirement |
| Anaesthesia | Airway management evidence (videolaryngoscopy, surgical airway), regional techniques, perioperative assessment, theatre-based SLEs or procedures | Required |
| Acute / General Medicine | Medical ward evidence, acute take assessments, interface cases where ICU and medical teams manage together, reflective entries on medical complexity | Required |
| Neuro ICM | Neurological critical illness cases, ICP evidence where applicable, neurosurgical ICU cases, or formal Neuro ICM placement evidence | Required |
| Cardiothoracic ICM | Cardiac surgery ICU cases, ECMO or VAD evidence where available, or post-cardiac arrest management evidence if direct CTICU exposure is limited | Required |
| Paediatric ICM | PICU placement evidence, paediatric critical illness cases, or paediatric transfer medicine evidence. Formal PICU placement strongly preferred | Required |
| Special Skills Year area | Full SSY curriculum evidence for chosen area - this is additional to the above and must map to the specific SSY curriculum document published by FICM | SSY specific |
The multi-specialty requirement creates a planning challenge that is specific to doctors who have been practising in a largely static post-consultant role. A doctor who has been a Trust Grade Consultant in a district general ICU for several years may have excellent general ICU evidence but significant gaps in anaesthesia, medicine, and specialist ICM areas. Addressing those gaps requires either a change of post, a planned secondment to a specialist centre, or evidence from earlier career stages that can still be mapped credibly to current competence.
The five-year evidence rule matters here: evidence of PICU practice from twelve years ago that you have not maintained is much weaker than a PICU placement arranged specifically to build current evidence. FICM's guidance, like most SSG documents, emphasises that the bulk of evidence should reflect current clinical practice. Earlier career evidence can contextualise and supplement, but it cannot substitute for current competence in the areas the curriculum requires.
SLEs, organ support, and procedural competence
Supervised Learning Events (SLEs) - the term the ICM curriculum uses for the range of workplace-based assessments - are central to ICM Portfolio Pathway evidence. The ICM curriculum includes mini-CEX assessments, Case-based Discussions (CbDs), Direct Observation of Procedural Skills (DOPS), and procedure-specific assessments. The key principle from the WBA guidance applies here with extra force: SLEs must come from multiple assessors, must be recent, and must reflect genuine clinical complexity rather than curated low-risk cases.
For ICM specifically, procedural competence matters in a way it does not in most medical specialties. ICU practice involves a range of invasive procedures - central venous access, arterial line insertion, bronchoscopy, chest drain insertion, renal replacement therapy initiation, and (in many centres) point-of-care ultrasound to FUSIC or FICE standard. The DOPS and procedure logbook must show breadth across these areas, not just the procedures the applicant happens to do most frequently.
Organ support evidence deserves particular attention. ICM is fundamentally a specialty built around sustaining organ function in the face of failure. An application that demonstrates extensive clinical experience but thin evidence of managing the full range of organ support - ventilator management, vasopressor and inotrope titration, renal replacement therapy, liver support where available - will raise questions in assessment even if overall experience is substantial. The evidence needs to show that the applicant has genuinely managed patients through the full complexity of critical illness, not just admitted and stabilised them before handing over.
Structured reports: the Clinical Director requirement
ICM requires a minimum of three structured reports. The composition of those three reports is more prescribed than in most other specialties. The ICM SSG specifies that reports must include the current workplace Clinical Director and at least two recent colleagues - both practising Intensive Care Medicine within the last two years.
ICM structured report requirements
Clinical Director (current workplace)
Must be from the Clinical Director of the ICU where the applicant currently practises. Provides governance-level assurance that the applicant's practice is at an appropriate Consultant standard and occurs within a properly structured ICU department. Cannot be replaced by a medical director or a line manager who is not the ICU Clinical Director.
Recent ICM Consultant colleague
A practising ICM Consultant from within the last two years who can speak to the applicant's clinical standard, decision-making, and teamwork in the ICU environment. Must be a current practising intensivist, not a retired colleague or someone from a different specialty.
Recent ICM Consultant colleague
A second practising ICM Consultant from within the last two years. Ideally from a different clinical context from Report 2 - for example, a colleague from a time-limited secondment rather than a second person from the same unit - to provide independent corroboration of the applicant's standard.
The Clinical Director report is the element most commonly underestimated by applicants. In most other specialties, the structured reports can come from any combination of senior clinical colleagues, educational supervisors, or consultants who have worked with the applicant. In ICM, one of the three must specifically be the Clinical Director of the current ICU. This is an institutional governance check, not just a character reference: the Clinical Director is being asked to confirm that the applicant practises at a level consistent with independent Consultant-level ICU practice within a properly governed ICU environment.
This requirement creates a specific challenge for ICU doctors in non-standard employment arrangements - for example, those working primarily through agency or locum contracts across multiple units, where no single Clinical Director can speak to the full picture of current practice. The solution in these situations is usually to establish a more settled practice relationship with one ICU for long enough that the Clinical Director there can speak authoritatively about current standards, supplemented by the other two colleague reports from additional settings. Simply presenting three reports from colleagues and none from a Clinical Director will not satisfy the SSG requirement.
The dual-trained doctor: ICM with anaesthetics or medicine
A substantial proportion of ICM Consultants in the UK hold dual training in ICM and either anaesthetics or acute/emergency medicine. The anaesthetics Portfolio Pathway and the ICM Portfolio Pathway are entirely separate processes, assessed by different bodies (RCoA for anaesthetics, FICM for ICM) against entirely different curricula. There is no combined application, no shared evidence submission, and no accelerated route for dual-trained doctors.
What the dual-trained doctor does have is an evidence base that is naturally richer in the complementary specialty areas than a single-specialty ICM practitioner. An anaesthetics-trained doctor applying for ICM Portfolio Pathway will have strong airway evidence, perioperative care evidence, and regional anaesthesia experience - all of which map directly to HiLLO 6 and contribute to the multi-specialty placement requirement. An acute/emergency medicine background contributes directly to HiLLO 7. This is genuine advantage: the evidence already exists and needs documentation rather than acquisition.
The challenge for dual-trained applicants is one of presentation rather than evidence. Each application must stand alone as an ICM application or an anaesthetics application. Material assembled for the anaesthetics application can inform the ICM application, and vice versa, but each submission must demonstrate the complete curriculum of the respective specialty. Presenting an anaesthetics application to FICM for ICM assessment, or vice versa, confuses the format and risks the assessors finding gaps in ICM-specific requirements that the anaesthetics curriculum does not cover. Each application needs its own index, its own HiLLO or capability mapping, and its own evidence narrative.
For doctors considering both routes, the practical question is sequencing. Assembling two simultaneous applications doubles the administrative load and the risk of gaps in one while focusing on the other. Most dual-trained doctors who have completed Portfolio Pathway through both routes report that tackling one at a time - typically ICM first if it is the primary practice, then anaesthetics - is more manageable than running them in parallel, even if the evidence base for both exists already.
Common gaps and deferral triggers
ICM Portfolio Pathway deferral requests cluster around predictable areas. Understanding these before assembly begins is more useful than discovering them after the first submission has been returned. The gaps below reflect the pattern in FICM guidance and the areas the SSG specifically flags as requiring explicit evidence.
What the ideal NHS post looks like for ICM Portfolio Pathway
For a non-training-grade ICU doctor building or completing an ICM Portfolio Pathway evidence base, the ideal NHS post provides several things simultaneously. Understanding what those things are helps in assessing current posts and in identifying where a change might be worth considering.
The core requirement is a general ICU post at a tertiary or major district general centre that offers both adult general ICU and access to specialist services - ideally neuro ICU, cardiac ICU, and PICU either within the same Trust or through a formal network arrangement. A genuinely general ICU that receives transfers from specialist centres is much more useful than a smaller standalone ICU, even if the clinical work is interesting, because it provides the multi-specialty exposure the curriculum requires.
Beyond the clinical environment, the post needs to support evidence collection. That means an educational supervisor or a senior clinical colleague willing to provide SLEs, a structured relationship with someone who understands the Portfolio Pathway, access to FICM-aligned logbook systems, and a job plan that includes quality improvement, formal teaching, governance and leadership, and research or publications time. A pure clinical post with no SPA time and no governance involvement is hard to build a complete HiLLO-mapped portfolio from, however clinically rich it is.
The SSY area also needs to be planned into the post or the career structure around it. If the chosen SSY is Neuro ICM, the job plan needs to include regular neuro ICU sessions at a centre with a genuine neuro ICU service, not occasional cover of an HDU that receives neurosurgical patients. Planning the SSY before committing to a post is more efficient than discovering post-appointment that the SSY component is not achievable from the role.
FICM guidance notes that the Portfolio Pathway application requires evidence that is predominantly within five years of submission. If your SSY was completed more than five years ago, you may need to refresh your SSY evidence before submitting - either through a refresher placement or through demonstrating that SSY-level practice has been maintained through your regular ICU work. Check the current FICM Portfolio Pathway guidance on evidence currency before deciding whether existing SSY evidence is sufficient.
For a complete picture of the costs and fees involved and a realistic view of the timeline, see those dedicated articles. The GMC application fee changes annually; always verify the current figure at the GMC fees page rather than relying on historical figures quoted elsewhere.
All 18 specialisms
Each specialty has its own SSG and its own assessment process. The links below go to the overview guides for all 18 specialisms currently covered.
Primary sources
| Source | Publisher | Relevance |
|---|---|---|
| Portfolio Pathway for Intensive Care Medicine | FICM | FICM's Portfolio Pathway guidance page: process, eligibility, and documentation requirements |
| Intensive Care Medicine CCT Curriculum 2021 | FICM | Definitive source for all 14 HiLLOs, stage structure, and SSY curriculum frameworks |
| Intensive Care Medicine Specialty Specific Guidance | GMC | GMC SSG for ICM Portfolio Pathway: evidence requirements, structured report specification, and assessment criteria |
| FFICM Fellowship Examination | FICM | FFICM structure, eligibility, and what the examination covers in relation to the ICM CCT curriculum |
| European Diploma in Intensive Care (EDIC) | ESICM | EDIC eligibility, syllabus, and recognition as a comparable qualification for ICM Portfolio Pathway purposes |
| Special Skills Year curricula | FICM | Individual SSY curriculum documents for each approved SSY area, used to map Portfolio Pathway SSY evidence |
| Portfolio Pathway - GMC overview | GMC | Overarching GMC guidance on the Portfolio Pathway process, including the GMC's role post-assessment |
| GMC fees page | GMC | Current Portfolio Pathway application fee (verify at this source; fees are updated annually) |
Frequently asked questions
Is FICM a Royal College?
No. The Faculty of Intensive Care Medicine is an independent Faculty, not a Royal College. It operates under its own governance and holds responsibility for the ICM CCT curriculum, the FFICM examination, and the Portfolio Pathway assessment process for ICM. This matters because in most other specialties the assessment body for Portfolio Pathway purposes is a Royal College; in ICM it is a Faculty. The GMC receives and makes the final determination on specialist registration, but the clinical assessment of evidence is handled entirely by FICM.
Is FFICM required for ICM Portfolio Pathway?
FFICM is the test of knowledge in the ICM CCT curriculum. FICM states there is no specialist medical qualification that gives automatic entry to the Specialist Register in ICM. Doctors who do not hold FFICM need to provide evidence of equivalent knowledge through an accepted comparable qualification such as EDIC, DICM, or FCICM where applicable, or through strong alternative knowledge evidence that spans the curriculum in depth. In practice, most Portfolio Pathway applicants either hold FFICM or EDIC. Applications without any examination evidence are possible but attract much closer scrutiny of every other knowledge-domain element of the submission.
What is the Special Skills Year in ICM Portfolio Pathway?
The ICM CCT curriculum requires acquisition of skills in an area related to ICM through a Special Skills Year. Portfolio Pathway applicants must declare their chosen SSY area and provide evidence that they have met the SSY curriculum requirements in that area. Common SSY areas include Neuro ICM, Cardiothoracic ICM, Paediatric ICM, and research or academic work. FICM notes that applicants who do not already hold SSY sign-off may need up to twelve months dedicated to their SSY area before they are ready to submit. The SSY evidence must be mapped to the specific SSY curriculum for the chosen area.
How many structured reports are needed for ICM Portfolio Pathway?
The ICM SSG requires a minimum of three structured reports. These must include the current workplace Clinical Director and at least two recent colleagues - both within the last two years - who are practising Intensive Care Medicine. The Clinical Director report is a specific requirement that does not apply in the same form in most other specialties; it is an additional assurance mechanism built into ICM Portfolio Pathway to verify that current practice is genuinely at consultant level and is occurring within a properly governed ICU setting.
Can a dual-trained ICM and anaesthetics doctor submit one Portfolio Pathway application for both specialties?
No. ICM and anaesthetics are separate entries on the Specialist Register and require separate Portfolio Pathway applications through their respective assessment bodies - FICM for ICM and the Royal College of Anaesthetists for anaesthetics. A doctor applying for both will need to assemble two parallel evidence portfolios, each independently meeting the requirements of the respective SSG. The evidence bases will overlap substantially, but each application is assessed independently. The timing of submissions can be coordinated, but there is no combined process.
What evidence period applies to the ICM Portfolio Pathway?
ICM follows the standard GMC Portfolio Pathway requirement that evidence should be current and predominantly within the last five years, with the most recent period of practice being the most important. Unlike some pathology specialties which operate a ten-year window, ICM evidence expectations are focused on recent clinical practice. Evidence of specific competencies that are no longer a regular part of current practice can be contextualised but will carry less weight than recent material. Always check the current FICM Portfolio Pathway guidance for the specific evidence window that applies at the time of your application.
Disclaimer: this article is general guidance, not legal or regulatory advice. GMC processes, FICM requirements, fees, and SSG content change; always verify current requirements directly with the GMC and FICM before making application decisions. The clinical review note in our site footer applies to all articles on this site.