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Critical Care Medicine

The Discipline

Critical care medicine encompasses the diagnosis and treatment of a wide variety of clinical problems representing the extreme of human disease. Critically ill patients require intensive care by a coordinated team. The critical care specialist (sometimes referred to as an “intensivist”) may be the primary provider of care or a consultant. The intensivist needs to be competent not only in a broad range of conditions common among critically ill patients but also with the technological procedures and devices used in intensive care settings. The care of critically ill patients also raises many complicated ethical and social issues, and the intensivist must be competent in areas such as end-of-life decisions, advance directives, estimating prognosis, and counseling of patients and their families.

Most physicians trained in critical care medicine work in hospital-based settings, usually in intensive care units. Within internal medicine, critical care medicine training is most commonly coupled with a pulmonary medicine fellowship since pulmonologists frequently oversee care of patients in intensive care units. However, other internal medicine physicians, such as cardiologists and general internists practicing hospital medicine, may seek training in critical care medicine to facilitate their work with severely ill patients.

Training

When combined with subspecialty training in pulmonary medicine (pulmonary and critical care medicine), a three year fellowship is required after which the trainee is eligible for subspecialty certification in both pulmonary medicine and critical care medicine.

For other internal medicine physicians, different routes of training in critical care medicine are available:

  • A two-year accredited fellowship in critical care medicine after the internal medicine residency
  • Two years of fellowship training in advanced general internal medicine (that include at least six months of critical care medicine) plus one year of accredited fellowship training in critical care medicine
  • Two years of accredited fellowship training in a subspecialty of internal medicine (three years for cardiovascular disease or gastrointestinal disease) plus one year of accredited clinical fellowship training in critical care medicine.

Certification in critical care medicine is jointly administered by the American Board of Internal Medicine, the American Board of Surgery, the American Board of Pediatrics, and the American Board of Anesthesiology.

Major Professional Societies

  • Society of Critical Care Medicine
  • American Thoracic Society
  • American College of Chest Physicians