Personal view
BMJ Mil Health: first published as 10.1136/bmjmilitary-2020-001463 on 27 March 2020. Downloaded from http://militaryhealth.bmj.com/ on October 29, 2020 at Auckland University
Fellowship in Immediate Medical Care
examination: applicability to the
Defence Medical Services
Oliver O’Sullivan ‍ ‍ ,1 R J Booker,2 H J Pynn3
Abstract
The Fellowship in Immediate Medical Care
(FIMC) is the highest level of formal qualifi-
cation available for pre-­hospital practitioners,
aiming to test the knowledge, technical and
non-­technical skills of those providing specialist
Pre-­
Hospital Emergency Care (PHEC). The
FIMC is a multiprofessional examination with
the potential to support continuous quality
improvement of the PHEC that the Defence
Medical Services (DMS) can offer to our patients
now and in the future. The aim of this article is
to inform the readership about the evolution
of the FIMC examination and its applicability
to military clinicians (and their civilian counter-
parts). A secondary aim is to inform those who
are preparing for the examination.
Introduction
The Fellowship in Immediate Medical
Care (FIMC) is the highest level of formal
qualification available for pre-­ hospital
practitioners. The examination is admin-
istered by the Royal College of Surgeons
of Edinburgh (RCSEd) and delivered by
their Faculty of Prehospital Care (FPHC).
It assesses competence in the knowledge,
technical and non-­ technical skills of
specialist Pre-­Hospital Emergency Care
(PHEC) providers at independent consul-
tant level practice.1 The aim of this article
is to inform the readership about the
evolution of the FIMC examination and
its applicability to military clinicians (and
their civilian counterparts). A secondary
aim is to inform those who are preparing
for the examination. A previous article
covered similar ground for the Diploma in
Immediate Care (DipIMC).2
In the recent years, the FIMC has under-
gone extensive changes to ensure it meets
the requirements of the curriculum and
assessment system written by the Intercol-
legiate Board for Training in Pre-­Hospital
1
Headquarters Army Medical Directorate (HQ AMD),
Camberley, UK
2
3 Medical Regiment Senior Medical Officer and Project
LARA Forward Instant Messaging trial lead, Preston, UK
3
Emergency Department, Bristol Royal Infirmary, Bristol,
UK
Correspondence to Oliver O’Sullivan, Headquarters
Army Medical Services (HQ AMS), Camberley GU15
4PQ, UK; ​oliver_​osullivan@​hotmail.​com
O'Sullivan O, et al. BMJ Mil Health Month 2020 Vol 0 No 0
Key messages
►► The Fellowship in Immediate
Medical Care (FIMC) is the highest
level of qualification available for
multiprofessional Pre-­Hospital
Emergency Care (PHEC) practitioners
meeting the eligibility criteria.
►► Specialist teams, including those who
will hold FIMC, are ever increasingly
delivering PHEC.
►► In order for the Defence Medical
Services (DMS) to deliver PHEC to
‘National Health Service standard
or better’, there is a requirement for
DMS clinicians to hold the FIMC.
►► This paper aims to explain the
evolution of the FIMC examination, its
applicability to the DMS and inform
prospective candidates of the format.
Emergency Medicine (IBTPHEM).1 Both
diploma and fellowship examinations are
based on National (UK) standards. There-
fore, candidates will not be examined on
regional or service-­specific standard oper-
ating procedures, but are examined on
documents that guide practice at national
level such as those produced by the FPHC,
the National Institute for Health and Care
Excellence, the Resuscitation Council
and the Joint Royal Colleges Ambulance
Liaison Committee,3–7 as well as organisa-
tions such as the European Union Aviation
Safety Agency.
Eligibility
There are two routes to become eligible
to attempt the FIMC, one for doctors
completing General Medical Council
(GMC) approved subspeciality training
programmes in Pre-­ Hospital Emergency
Medicine (PHEM), and one for doctors,
paramedics and nurses who can evidence
achievement of the same competencies via
alternative training pathways. The FIMC
became a multiprofessional examination
in 2016. To date, no nurses or paramedics
have sat the examination. In the future, it
is likely that specialist paramedics in crit-
ical care working on UK air ambulances
will be expected to attain the FIMC.
Potential candidates for the
examination
The majority of FIMC candidates will
continue be drawn from the parent special-
ties of Emergency Medicine (EM), Anaes-
thesia, Intensive Care Medicine or Acute
Medicine. In 2019, an Army General Prac-
titioner (GP) was the first GP to pass the
examination. There is now an Army GP
entering PHEM training every year and
so the pool of military GPs holding the
FIMC will steadily grow alongside their
secondary healthcare colleagues. There is
a recognition of the need for all military
GPs and General Duties Medical Officers
to be able to deliver PHEC to military
patients over a broad spectrum of mili-
tary activity including operational deploy-
ments and the permanent joint operating
bases, as well as Firm Base and Overseas
Training Exercises. Having a cohort of
Military GPs with the highest UK qualifi-
cation in PHEC will aid in the develop-
ment of this requirement.
Technology. Protected by copyright.
Application
There are two sittings of the FIMC
annually—in January and July. Applica-
tions are made via the RCSEd website,
with the application window closing 3
months prior to the examination dates.
The full eligibility criteria are detailed on
the RCSEd website. Candidates require
5 years of experience working in their
profession (with documented evidence),
professional accreditation and to hold the
DipIMC. Non-­ PHEM trainee applicants
need to demonstrate that their experience
is equivalent by submitting a portfolio of
evidence sufficient to be awarded a certif-
icate of eligibility3 (see Figure 1) which
incurs an additional cost and time to be
reviewed.
The examination
The examination consists of two parts (A
and B) as follows:
Part A is a multiple-­ choice question
paper of 180 min duration consisting of
180 single best answer questions.
Part B is an objective structured prac-
tical examination consisting of 14 testing
stations. Twelve of these stations will be
8 min duration and two will be 24 min.
Most of the 8 min stations will be simu-
lated patients with a clinical problem
to resolve. Other stations may require
the candidate to direct a complex resus-
citation with several assistants. There-
fore, it is worth practising an organised,
logical approach that includes the non-­
technical skills, such as task management,
team working, situational awareness and
   1
 Personal view
Figure 1  Application process for PHEM and non-­PHEM trainees.4 FIMC, Fellowship in Immediate
Medical Care; PHEM, prehospital emergency medicine; RCSEd, Royal College of Surgeons of
Edinburgh.
decision making. Other stations might
examine more ‘managerial’ curriculum
items, such as medicines management or
teaching a colleague a practical proce-
dure. Of the two 24 min stations, one will
be a ‘primary transfer’ where the candi-
date attends a patient in a simulated pre-­
hospital scenario, and the other will be a
‘secondary transfer’ of a patient from a
‘local’ hospital to a specialist centre.
Applicability to the Defence
Medical Services
PHEM was approved by the GMC as
a medical subspeciality in 2011. The
current IBTPHEM curriculum and assess-
ment system was established in 2014.1
Seriously ill and injured patients in the
UK are increasingly likely to be attended
by specialist PHEC teams that include
FIMC holders. For the Defence Medical
Services (DMS) to continue to offer our
patients the ‘National Health Service stan-
dard of care, or better (within operational
constraints)’ requires the sustainment of
clinical training pathways that include
the FIMC examination. The FIMC is a
nationally regulated examination that
provides a minimum standard of clinical
and managerial competence at consultant
level. Achieving this qualification will
provide evidence that the practitioner
has the necessary PHEM exposure and
skillset to attempt the Medical Emergency
Response Team (MERT) course, which
applies civilian PHEM clinical standards
into military-­specific situations: a compar-
ison can be made with other specialties
whereby achievement of the fellowship in
that specialty is required to attain a certif-
icate of completion of training to enable
2 O'Sullivan O, et al. BMJ Mil Health Month 2020 Vol 0 No 0
practitioners to then undergo military-­
specific training in that area. The chal-
lenges and rigours of working in military
PHEM are well known. Those able to
meet these challenges and rigours would
be expected to achieve the FIMC without
undue difficulty following formal PHEM
training and experience.
The Defence Consultant Advisor (DCA)
PHEC has declared that all military practi-
tioners who have entered PHEM training
since 2014 and are wishing to provide a
level 8 (Consultant in PHEM) capability
in a military role must have achieved the
FIMC.
It is imperative that military level 8
PHEM practitioners retain their clinical
skills with civilian Air Ambulances when
not deployed. Having the FIMC will
in the near future be a requirement to
undertake PHEM with a civilian critical
care team regardless of the clinical back-
ground of that practitioner (GP, EM, ITU
or Anaesthetics).
Conclusions
The FIMC is a demanding examination
but one that is achievable for many DMS
doctors and in the future, paramedics
and nurses. Supporting DMS clinicians
to achieve the FIMC in no way dimin-
ishes or de-­emphasises the importance
of allied healthcare providers such as
Combat Medical Technicians and nurses
continuing to provide clinical care at
different levels of PHEC capability.8
Rather the FIMC examination promotes
strong medical leadership within all
areas of pre-­hospital clinical practice, a
key element to safely managing PHEC
systems supporting military activity from
BMJ Mil Health: first published as 10.1136/bmjmilitary-2020-001463 on 27 March 2020. Downloaded from http://militaryhealth.bmj.com/ on October 29, 2020 at Auckland University
divisional war fighting to Sovereign Base
Area ambulance services. Level 8 PHEM
will be increasingly delivered by FIMC
holders in both military and civilian
specialist PHEC teams.
Contributors  OO designed, developed and initially
drafted the article. RJB and HJP redrafted, edited and
provided specialist input.
Funding  The authors have not declared a specific
grant for this research from any funding agency in the
public, commercial or not-­for-­profit sectors.
Competing interests  None declared.
Patient consent for publication  Not required.
Provenance and peer review  Not commissioned;
internally peer reviewed.
© Author(s) (or their employer(s)) 2020. No commercial
re-­use. See rights and permissions. Published by BMJ.
►► Additional material is published online only. To view
please visit the journal online (http://​dx.​doi.​org/​10.​
1136/​bmjmilitary-​2020-​001463).
To cite O’Sullivan O, Booker RJ, Pynn HJ.
BMJ Mil Health Epub ahead of print: [please include
Technology. Protected by copyright.
Day Month Year]. doi:10.1136/
bmjmilitary-2020-001463
Received 11 March 2020
Accepted 14 March 2020
BMJ Mil Health 2020;0:1–2.
doi:10.1136/bmjmilitary-2020-001463
ORCID iD
Oliver O’Sullivan http://​orcid.​org/​0000-​0002-​9184-​
4713
References
1 Intercollegiate Board for Training in Pre-­hospital
Emergency Medicine. Sub-­specialty training in
pre-­hospital emergency medicine: curriculum and
assessment system. Available: http://www.​ibtphem.​
org.​uk/​media/1​ 039/​sub-s​ pecialty-​training-​in-​phem-​
curriculum-​assessment-​system-​edition-​2-​2015.​pdf
2 O’Sullivan O, Osborne L, Pells G. Updated diploma in
immediate medical care: applicability to military and
civilian clinicians. J R Army Med Corps 2019;165:360–2.
3 FPHC. Regulations for the issue of a certificate of FIMC
eligibility. Available: (https://f​ phc.​rcsed.​ac.​uk/​media/​
1628/​fimc-​certificate-e​ ligibility-​regs-2​ 8-​april-​15.​pdf
[Accessed Dec 2019].
4 FPHC. Review of the diploma and fellowship in
immediate medical care exam diets 2014-2019.
Available: https://​fphc.​rcsed.​ac.u​ k/​media/​2696/​review-​
of-​dimc-​and-​fimc-​exams-2​ 014-​2019.​pdf [Accessed Jun
2019].
5 Consensus statements. Faculty of pre-­hospital care.
Available: https://​fphc.​rcsed.​ac.u​ k/​my-​fphc/​resources/​
consensus-​statements [Accessed Dec 2019].
6 Resuscitation Council UK. Resuscitation guidelines.
Available: https://www.​resus.o​ rg.​uk/​resuscitation-​
guidelines/ [Accessed Dec 2019].
7 Joint Royal Colleges Ambulance Liaison Committee.
United Kingdom ambulance services clinical practice
guidelines 2016. Class Publishing, 2018.
8 Sharpe D, McKinlay J, Jefferys S, et al. Military
prehospital emergency care: defining and
professionalising the levels of care provided along the
operational patient care pathway. J R Army Med Corps
2019;165:188–92.