A Case for Change in Adult Critical Care Training for Physicians in the United States: A White Paper Developed by the Critical Care as a Specialty Task Force of the Society of Critical Care Medicine

Objectives: In the United States, physician training in Critical Care Medicine has developed as a subspecialty of different primary boards, despite significant commonality in knowledge and skills. The Society of Critical Care Medicine appointed a multidisciplinary Task Force to examine alternative approaches for future training. Design: The Task Force reviewed the literature and conducted informal discussions with key stakeholders. Specific topics reviewed included the history of critical care training, commonalities among subspecialties, developments since a similar review in 2004, international experience, quality patient care, and financial and workforce issues. Main Results: The Task Force believes that options for future training include establishment of a 1) primary specialty of critical care; 2) unified fellowship and certification process; or 3) unified certification process with separate fellowship programs within the current specialties versus 4) maintaining multiple specialty-based fellowship programs and certification processes. Conclusions: 1) Changing the current Critical Care Medicine training paradigms may benefit trainees and patient care. 2) Multiple pathways into critical care training for all interested trainees are desirable for meeting future intensivist workforce demands. 3) The current subspecialties within separate boards are not "distinct and well-defined field[s] of medical practice" per the American Board of Medical Specialties. Recommendations for first steps are as follows: 1) as the society representing multidisciplinary critical care, the Society of Critical Care Medicine has an opportunity to organize a meeting of all stakeholders to discuss the issues regarding Critical Care Medicine training and consider cooperative approaches for the future. 2) A common Critical Care Medicine examination, possibly with a small percentage of base-specialty–specific questions, should be considered. 3) Institutions with multiple Critical Care Medicine fellowship programs should consider developing joint, multidisciplinary training curricula. 4) The boards that offer Critical Care Medicine examinations, along with national critical care societies, should consider ways to shorten training time. Drs. Tisherman and Spevetz are Co-Chair persons. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Supported, in part, by the Society of Critical Care Medicine. Dr. Tisherman has disclosed that he represents the Society of Critical Care Medicine (SCCM) on the Trauma, Burns, and Critical Care Board of the American Board of Surgery, and he is also President of the Surgical Critical Care Program Directors Society. Dr. Spevetz has disclosed that she serves as the SCCM representative to the American Board of Internal Medicine (ABIM) Liaison committee on Certification and Recertification. Dr. Brown serves as an examiner for the American Board of Anesthesiology. Dr. Chang received funding from SCCM (Council Member; financial relationship related only to reimbursement for travel expenses and complimentary registration for the annual congress; no honoraria), the Neurocritical Care Society (Past-President; nonvoting, ex-officio member of the Board of Directors; financial relationship limited to travel expenses to stand-alone Board meetings; no honoraria), ABIM Critical Care Medicine Certification Examination Writing Committee (current member, travel expenses and honorarium), and received reimbursement for travel and honoraria for lectures at annual meetings from the American College of Physicians, and from the Indonesian SCCM for a Multiprofessional Critical Care Review Course for Continuing Education Program for their membership. She also disclosed that she was the Co-Chair (Past/Inaugural Chair) for the Neurocritical Care Examination Writing Committee of the United Council of Neurological Subspecialties and the Certification Committee for the Neurocritical Care Society. Dr. O'Connor received funding from CLEW (previously known as Intensix; scientific advisory board). Dr. Sevransky's institution received funding from the Marcus Foundation, and he received funding from SCCM (Associate Editor stipend). He is an associate editor of Critical Care Medicine. Dr. Wessman is the Program Director for the Anesthesiology Critical Care Medicine Fellowship at Washington University of St. Louis and the Chair of the SCCM Emergency Medicine Section. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: stisherman@umm.edu Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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