ICM logbook summary

 

Please use a CROSS (X) for each question and complete this form in BLOCK CAPITALS and BLACK ink.

Trainee’s surname

 

Trainee’s forename(s)

 

GMC Number

 

GMC NUMBER MUST BE COMPLETED

 

Hospital placement:

 

Duration of placement:

 

 

Total beds:

Level 2:                    Level 3:                    Mixed 2/3:

Level of training:

Core                         Step 1        Step 2         Step 3    

Speciality:

General          Cardiac         Neuro         Paeds    

Total unit admissions during placement:

 

 

Event

Local supervision

Distant supervision

Teaching

Ward review

 

 

 

Admission

 

 

 

Lead ward round

 

 

 

Cardiac arrest

 

 

 

Trauma team

 

 

 

Intra-hospital transfer

 

 

 

Inter-hosptial transfer

 

 

 

Discussion with relatives

 

 

 

End of life care/donation

 

 

 

 

 

 

 

 

 

 

 

 

Procedure

Local supervision

Distant supervision

Teaching

Airway & Lungs

Emergency intubation

 

 

 

Percutaneous tracheostomy

 

 

 

Bronchoscopy

 

 

 

Chest drain - seldinger

 

 

 

Chest drain – blunt dissection

 

 

 

Lung ultrasound

 

 

 

Cardiovascular

Arterial cannulation

 

 

 

Central venous access – IJ

 

 

 

Central venous access – SC

 

 

 

Central venous access – Femoral

 

 

 

Pulmonary artery catheter

 

 

 

Non-invasive CO monitoring

 

 

 

Echocardiogram

 

 

 

Abdomen

Ascitic drain/tap

 

 

 

Sengstaken tube placement

 

 

 

Abdominal ultrasound/FAST

 

 

 

CNS

Lumbar puncture

 

 

 

Brainstem death testing

 

 

 

Experience of the all the above procedures is desirable but NOT essential