Educational and Training Programs in Intensive Care Medicine are the Right Way

Abstract

Intensive care medicine (ICM) is a relatively young discipline, and even more recent is the attempt to provide formal certifications for those with a particular qualification or specialists in this field: the first examination dedicated to intensivists was introduced by the Australian Faculty of Anesthetists in 1979 (1). In many countries, intensive care medicine developed as part of other specialties: both surgical and several medical specialties developed their own ICM training programs, splitting ICM knowledge in specific sub-sections. This approach was overcome starting from the 1970s, when in Europe and in the United States ICM training programs became a fundamental part of the debate on how ICM should develop. So far, three main models can be identified worldwide, namely the development of ICM: 1) within related medical or surgical specialties, 2) as a stand-alone recognized specialty or 3) as a hybrid of these two ("super specialty"), as frequently occurs (2). Therefore, the ICM educational path can either consist in a complete stand-alone specialization school, a training program with multidisciplinary access with a common curriculum or, as other option, training programs available only for specific specialists, typically anesthesiologists (3). Anesthesiology includes anaesthesia, perioperative care, intensive care medicine, emergency medicine and pain therapy, and it acknowledged as a leading medical specialty in addressing issues of patient safety (4). For this reason, anesthesiology is the base specialty most frequently linked to ICM; others that provide access in some European countries include emergency medicine, internal and pulmonary medicine, cardiology, nephrology, neurosurgery, trauma, neonatology and paediatrics (5). Defining the professional figure of the intensivist, whose mandate is to take care of the critical ill patient and of everything is associated with him or her, including rehabilitation period after ICU discharge and families, is a noble purpose, but overlaps with several political issues (6). As of today, ICM does not fully satisfy the criteria to be recognized as primary specialty according to the European Directive 2005/36/EC on the recognition of professional qualifications since it was not approved as independent discipline by at least one third of the Member States according to the European Union of Medical Specialists (UEMS) (7). In Italy and several North-European countries, ICM is considered a natural development of anaesthesiology competences and formal training programs have been introduced. Conversely, in countries like Spain and Switzerland, ICM is considered as primary specialty. The United Kingdom is a leading country in the competence-based training of intensivists, and has a complex system of evaluation and certification of skills. Of notice, in many countries where ICM is a primary specialty, the first years of training are however spent in anaesthesiology. ICM is intrinsically multidisciplinary (8)

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“…would like to begin with compliments to the article Ball et al (1). The article mainly concentrates on the education and training aspects.…”