Time for change in critical care training, society says

A new white paper from the Society of Critical Care Medicine calls for development of a common critical care medicine examination cosponsored by the medical specialty boards overseeing the subspecialty.


Both physicians and patients may benefit from changes to the current model of critical care training, according to a recent white paper from the Society of Critical Care Medicine.

The white paper, which was developed by the society's Critical Care as a Specialty Task Force, noted that critical care training in the U.S. “has evolved into parallel, subspecialty tracks within the specialties of medicine, surgery, anesthesia, neurology, and neurosurgery.” The goal of the task force was to look at different approaches to future training that would consider the similarities among the current pathways, as well as economic and staffing issues. After a review of the literature and informal discussions with key stakeholders, the task force developed a list of conclusions and first steps in a white paper published June 28 by Critical Care Medicine.

The task force concluded that graduates of the current critical care medicine training system do not have uniform expertise in managing a broad spectrum of critically ill patients and that multiple pathways into critical care training, along with inclusion of all interested trainees, are needed to meet future workforce demands. “Considering the similarities in program requirements, milestones, and board examination content, the current subspecialties based in separate boards do not meet the [American Board of Medical Specialties] medical specialty board requirements for being ‘distinct and well-defined field[s] of medical practice,’ lending further credence to the need for change,” the task force wrote.

The task force recommended the following steps:

  1. 1. The Society of Critical Care Medicine has an opportunity to organize a meeting of all stakeholders to discuss critical care medicine training and consider cooperative approaches for the future.
  2. 2. A common critical care medicine examination, cosponsored by the separate boards, should be developed. “One consideration may be to design the examination in a modular fashion with a large percentage of common questions and a small percentage of base-specialty-specific questions,” the task force wrote.
  3. 3. Institutions that have multiple fellowship training programs for critical care medicine should be encouraged to develop joint, multidisciplinary training curricula.
  4. 4. The boards that offer critical care medicine examinations and the national critical care societies should discuss ways to shorten the required intensivist training.

“These changes will not be easy and will require the primary specialties to reexamine their training paradigms and work together for the betterment of patients and trainees,” the task force wrote. “It is time to explore new ways to educate intensivists of the future to be prepared to manage the patients of the future.”

A recent article in ACP Hospitalist discussed hospitalist involvement and training in critical care.