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Training Internists to Meet Critical Care Needs in the United States: A Consensus Statement from the Critical Care Societies Collaborative (CCSC)*

Prepared by the CCSC Task Force on Critical Care Educational Pathways in Internal Medicine

doi: 10.1097/CCM.0000000000000250
Special Article

Objectives: Multiple training pathways are recognized by the Accreditation Council for Graduate Medical Education (ACGME) for internal medicine (IM) physicians to certify in critical care medicine (CCM) via the American Board of Internal Medicine. While each involves 1 year of clinical fellowship training in CCM, substantive differences in training requirements exist among the various pathways. The Critical Care Societies Collaborative convened a task force to review these CCM pathways and to provide recommendations for unified and coordinated training requirements for IM-based physicians.

Participants: A group of CCM professionals certified in pulmonary-CCM and/or IM-CCM from ACGME-accredited training programs who have expertise in education, administration, research, and clinical practice.

Data Sources and Synthesis: Relevant published literature was accessed through a MEDLINE search and references provided by all task force members. Material published by the ACGME, American Board of Internal Medicine, and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force reached consensus using a roundtable meeting, electronic mail, and conference calls.

Main Results: Internal medicine-CCM–based fellowships have disparate program requirements compared to other internal medicine subspecialties and adult CCM fellowships. Differences between IM-CCM and pulmonary-CCM programs include the ratio of key clinical faculty to fellows and a requirement to perform 50 therapeutic bronchoscopies. Competency-based training was considered uniformly desirable for all CCM training pathways.

Conclusions: The task force concluded that requesting competency-based training and minimizing variations in the requirements for IM-based CCM fellowship programs will facilitate effective CCM training for both programs and trainees.

Task Force Members: Stephen M. Pastores, MD, FCCM (Co-Chair), Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Greg S. Martin, MD, MSc, FCCM (Co-Chair), Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA; Michael H. Baumann, MD, MS, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS; J. Randall Curtis, MD, MPH, Harborview Medical Center, University of Washington, Seattle, WA; J. Christopher Farmer, MD, FCCM, Mayo Clinic Arizona, Phoenix, AZ; Henry E. Fessler, MD, Johns Hopkins University School of Medicine, Baltimore, MD; Rakesh Gupta, MD, Orlando Health/Orlando Regional Medical Center, Orlando, FL; Nicholas S. Hill, MD, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA; Robert C. Hyzy, MD, FCCM, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI; Vladimir Kvetan, MD, FCCM, Director, Critical Care Medicine Montefiore Medical Center Professor of Anesthesiology and Clinical Medicine Director, Division of Critical Care/Department of Medicine Albert Einstein College of Medicine, Bronx, NY; Drew A. MacGregor, MD, Wake Forest University Health Sciences, Winston-Salem, NC; Naomi P. O’Grady, MD, FCCM, National Institutes of Health, Bethesda, MD; Frederick P. Ognibene, MD, FCCM, National Institutes of Health, Bethesda, MD; Gordon D. Rubenfeld, MD, Sunnybrook Health Sciences Centre Trauma, Emergency and Critical Care Program, Toronto, ON, Canada; Curtis N. Sessler, MD, FCCM, Orhan Muren Professor of Medicine Director, Center for Adult Critical Care Virginia Commonwealth University Health System Medical College of Virginia Hospitals and Physicians, Richmond, VA; Eric Siegal, MD, Aurora Health Care, and the University of Wisconsin School of Medicine and Public Health, Madison, WI; Steven Q. Simpson, MD, Division of Pulmonary and Critical Care, University of Kansas, Kansas City, KS; Antoinette Spevetz, MD, FCCM, Cooper Medical School of Rowan University Cooper University Hospital, Camden, NJ; Nicholas S. Ward, MD, FCCM, Division of Pulmonary, Critical Care, and Sleep Medicine Alpert Medical School of Brown University, Providence, RI; Janice L. Zimmerman, MD, FCCM, Professor of Clinical Medicine Weill Cornell Medical College Division Head, Critical Care Houston Methodist Hospital, Houston, TX.

Dr. Pastores’ institution received grant support from Spectral Diagnostics (Dr. Pastores is principal investigator at MSKCC for a septic shock clinical trial) and Bayer Healthcare (Dr. Pastores is principal investigator at MSKCC for a gram-negative pneumonia clinical trial). Dr. Martin served as an advisory board member for Cumberland Pharmaceuticals and Pulsion Medical Systems and his institution received grant support from NIH, FDA, Baxter Healthcare, and Abbott Laboratories. Dr. Baumann served as board member for ACCP Board of Regents, is employed by the University of Mississippi Medical Center, received support for the development of educational presentations (various post graduate courses and other products for ACCP and/or ATS), and received support for travel (paid as part of ACCP Board of Regents). Dr. Curtis’ institution received grant support from NIH and PCORI. Dr. Fessler received support for development of educational presentations from Oakstone Medical Publishers (Payment for editorial services for a monthly journal review digest in CCM) and received support for travel from American Thoracic Society (Travel expenses to attend committee meetings) and the Association of Pulmonary and Critical Care Medicine Program Directors (Travel expenses to attend committee meetings or to represent the Association at professional society meetings). Dr. O’Grady served as a board member for ABIM and is a government employee. Dr. Ognibene is an employee of the U.S. government and has no copyright authority. Dr. Simpson received support for travel from the Surviving Sepsis Campaign (Planning committee for national sepsis collaborative) and other: IMPRESS Study (North American Co-Chair for the International Multicenter Prevalence Study on Sepsis; no honorarium). His institution received grant support from Kansas City Area Life Sciences Foundation (Grant for sepsis quality improvement work in Kansas City). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: pastores@mskcc.org

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins