INTRODUCTION
Internal medicine (IM) physicians constitute a significant proportion of intensivists. The Accreditation Council for Graduate Medical Education (ACGME) recognizes several pathways for IM physicians to achieve board certification in critical care medicine (CCM) through the American Board of Internal Medicine (ABIM) (1, 2). These pathways, outlined in Table 1, while all including a year of clinical fellowship in CCM, exhibit notable variations in their training requirements (Table 2). These discrepancies, while potentially intended to accommodate diverse trainee backgrounds, may create unnecessary obstacles to optimal CCM training. This article, based on a task force convened by the Critical Care Societies Collaborative (CCSC), examines these CCM pathways for IM-based physicians. We aim to propose recommendations for the ACGME to foster more unified and coordinated educational standards, thereby enhancing the quality and consistency of CCM training. Our recommendations seek to streamline the educational process and address potential barriers within the current system, ultimately benefiting both training programs and aspiring intensivists.
Table 1.
Pathways for Admission of Medical Intensivists to Critical Care Certification2
| Pathway Aa |
|---|
| • 2 years of accredited fellowship training in a subspecialty of internal medicine (3 years for cardiovascular disease and gastroenterology), including critical care unit patient managementb |
| • Certification by American Board of Internal Medicine in the subspecialty |
| • 1 year of accredited clinical fellowship training in critical care medicine within department of medicine |
| Pathway B |
| • 2 years of accredited fellowship training in critical care medicine (including 12 months of full-time clinical training) within department of medicine |
| Pathway Cc |
| • 2 years of fellowship training in advanced general internal medicine that includes at least 6 months of critical care medicine |
| • 1 year of accredited fellowship training in critical care medicine within department of medicine |
Table 1: ACGME Pathways to Critical Care Medicine Certification for Internal Medicine Physicians.
aDiplomates of American Board of Internal Medicine with neurology certification from the American Board of Psychiatry and Neurology may apply via pathway A if neurology training included critical care unit patient management and the additional year of accredited critical care medicine fellowship training is sponsored by an internal medicine department.
bCandidates pursuing dual certification in pulmonary disease and critical care medicine must complete a minimum of 3 years of combined accredited training, with at least 18 months of clinical training. Pulmonary disease certification must precede application for the critical care medicine examination.
cCurrently, no fellowship in advanced general internal medicine is available through Accreditation Council for Graduate Medical Education.
Table 2.
Key Differences in Specialty-Specific Training Requirements for Critical Care Medicine in the United States
| IM-CCM | PULMONARY-CCM | ANESTHESIOLOGY-CCM | SURGERY-CCM |
|---|---|---|---|
| Site Requirements | |||
| – • IM and general surgery residencies | – • IM and general surgery residencies | – • Requires an ACGME-accredited anesthesia residency at the primary clinical site or an integration agreement with another institution sponsoring an anesthesia residency – • IM and general surgery residencies | – • Must sponsor an ACGME-accredited residency program in surgery, pediatric surgery, thoracic surgery, or vascular surgery – • Desirable to have IM, anesthesiology, pathology, and radiology programs |
| – • Must have at least 3 of 5 IM subspecialty programs (cardiovascular disease, gastroenterology, infectious diseases, nephrology, or pulmonary disease) at the primary clinical site | – • Must have pulmonary disease subspecialty program plus 2 of 4 IM subspecialty programs (cardiovascular disease, gastroenterology, infectious diseases, or nephrology) at the primary clinical site | – • No additional fellowship required | – • No additional fellowship required |
| Key Clinical Faculty Requirements | |||
| – • Must have current ABIM certification in CCM – • 2 KCF if ≤3 fellows (in addition to program director) – • 1 KCF:1 fellow for programs with more than 3 fellows. | – • Must have current ABIM certification in pulmonary disease or CCM (at least 3 KCF must be board-certified in pulmonary disease and at least 3 must be certified in CCM) – • 5 KCF (in addition to program director) – • 1 KCF:1.5 fellows if >9 fellows | – • Faculty must be board-certified in anesthesia or possess acceptable qualifications – • No mention of KCF – • ≥2 more FTE faculty with expertise in critical care – • Ratio of 1 FTE faculty to 2 fellows must be maintained | – • No mention of KCF – • At least 1 surgeon certified in surgical critical care must be appointed to the faculty for every critical care fellow in the program (in addition to program director). Must have current certification in the subspecialty by the American Board of Surgery or possess acceptable qualifications – • Nonsurgical physician faculty must be certified in critical care in their specialty area or possess acceptable alternative qualifications |
| Bronchoscopy Requirements | |||
| – • 50 therapeutic flexible fiberoptic bronchoscopy procedures limited to indications for therapeutic removal of airway secretions, diagnostic aspiration of airways secretions or lavage fluid, or airway management | – • 100 bronchoscopy procedures | – • Not required | – • Not required |
| EM Trainee Requirements | |||
| – • 75% of fellows must be graduates of an ACGME-accredited IM program averaged over any 5-year period (limiting EM-CCM fellows to 25%) – • EM-CCM fellows must have a minimum of 6 months of IM rotations with at least 3 months in a medical ICU; if not completed during EM residency, they must be completed at the beginning of the first fellowship year | – • Not applicable | – • Not applicable | – • Fellows completing EM residency must also complete a preliminary year in surgery at the institution where they will enroll in surgical critical care fellowship |
| Clinical Time and ICU Requirements | |||
| – • Minimum 12 months of clinical experiences – • At least 6 months of care of critically ill medical patients (i.e., MICU/CICU or equivalent) – • At least 3 months of care of critically ill non-medical patients (at least 1 month direct patient care) – • Up to 3 months of MICU/CICU experience during another IM subspecialty fellowship may count towards the 6 months of required MICU/CICU time – • Any clinical experience done by EM-CCM fellows to fulfill prerequisite IM clinical requirements will not count towards the minimum 12 months of critical care experience | – • Minimum 18 months of clinical experiences – • At least 6 months of care of critically ill medical patients (i.e., MICU/CICU or equivalent) – • At least 3 months of care of critically ill non-medical patients (at least 1 month direct patient care) – • No more than 15 months of ICU experience | – • Minimum 12 months of full-time training – • At least 9 months must be spent in the care of critically ill patients in ICUs | – • 12 months of training – • At least 8 months must be in a surgical ICU (at least 5 months must be in a unit where a surgeon is the director or co-director) – • No more than 2 months in nonsurgical ICUs – • No more than 2 months in elective rotations relevant to critical care |
Table 2: A comparative overview of key differences in ACGME training requirements across various critical care medicine specialties in the United States.
Abbreviations: ABIM=American Board of Internal Medicine; ACGME=Accreditation Council on Graduate Medical Education; CCM=critical care medicine; EM=emergency medicine; ICU=intensive care unit; MICU=medical intensive care unit; CICU=cardiac intensive care unit; IM=internal medicine; KCF=key clinical faculty; FTE=full time equivalent.
TASK FORCE ORIGIN AND OBJECTIVES
Recognizing the necessity for standardized and high-quality training in critical care medicine for internists, the Critical Care Societies Collaborative (CCSC) established a task force in Fall 2012. This initiative was driven by the need to address the evolving demands of critical care in the United States and to ensure that training pathways for IM-trained intensivists are both robust and consistent. The CCSC, comprising representatives from the American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), tasked this group of experts with developing a consensus statement. Their mission was to propose recommendations aimed at standardizing the educational process for IM physicians aspiring to specialize in critical care. While the American Association of Critical-Care Nurses, a CCSC member, opted not to participate directly, they expressed support for the task force’s endeavors.
The core objective of the task force was to critically assess the current landscape of CCM training for internists and identify areas where standardization and harmonization of ACGME program requirements could enhance training efficacy. This involved a comprehensive review of existing training pathways, an analysis of the rationale behind current requirements, and the development of evidence-based recommendations for improvement. The ultimate goal was to create a more streamlined and effective educational framework that prepares IM-trained physicians to excel in the complex and demanding field of critical care medicine.
METHODOLOGY
To effectively address the complexities of critical care medicine training, the task force adopted a rigorous and collaborative approach. The leadership of CCSC and key stakeholders worked together to assemble a diverse group of participants. These individuals were selected from ACGME-accredited CCM training programs and possessed extensive expertise across clinical practice, education, research, and administration. Crucially, task force members had direct experience in training fellows in IM-based CCM programs, representing both IM-CCM and Pulmonary-CCM tracks. This blend of perspectives ensured a comprehensive and nuanced understanding of the challenges and opportunities within CCM education.
The task force was specifically charged with examining several critical issues: the current state of the CCM physician workforce, the existing educational processes and training requirements for CCM certification for IM physicians, the obstacles in creating uniform CCM training pathways for internists, and the formulation of training recommendations to inform accrediting bodies.
The task force’s recommendations were guided by four fundamental principles:
- Evidence-Based Approach: Recognizing the limitations of direct evidence in defining optimal training requirements for IM-based critical care, recommendations were grounded in established principles, international standards, and the collective experience and consensus of the task force members.
- Competency-Based Training: The task force emphasized that critical care training for internists should prioritize the acquisition of specific critical care competencies, aligning with broader ACGME training standards.
- Workforce Considerations: While acknowledging the importance of physician workforce projections in determining the appropriate number of CCM training positions, the task force asserted that these projections should not dictate the content or duration of training required to produce a competent critical care clinician.
- Justification for Variation: The task force underscored the need for a clear and explicit rationale for any variations in requirements across IM-based critical care training programs, advocating for the elimination of unjustified discrepancies.
To gather information and inform their deliberations, the task force conducted a thorough review of relevant literature. This included searches of MEDLINE and examination of references provided by task force members. They also reviewed materials published by key organizations including the ACGME, ABIM, and other specialty societies. The task force utilized conference calls, email exchanges, and an in-person meeting held on January 20, 2013, during the SCCM Congress to facilitate discussion and consensus-building. The final draft of their recommendations was then presented to the leadership of ACCP, ATS, and SCCM for review, feedback, and official endorsement from each organization, ensuring broad support and alignment within the critical care community.
INTERNAL MEDICINE, CRITICAL CARE MEDICINE TRAINING, AND THE INTENSIVIST WORKFORCE SHORTAGE
The demand for critical care services in the United States has dramatically increased over the past three decades, outpacing growth in many other areas of healthcare (3, 4). Numerous studies support the positive impact of intensivist involvement in the care of critically ill patients (5–9). Factors such as the aging population, recommendations from the Leapfrog Group for ICU staffing (10), and ACGME resident duty-hour limitations (11, 12) have collectively amplified the workload for intensivists and other critical care providers (13). These trends have led to consistent projections of a growing intensivist shortage in the foreseeable future (14–17). This shortage poses a significant challenge to the healthcare system’s ability to provide optimal care for critically ill patients.
The escalating demand for intensivists highlights the critical need for robust and efficient training programs in critical care medicine.
This imbalance between ICU staffing supply and demand could negatively impact the attractiveness of CCM careers for new trainees and create unsustainable working conditions for practicing intensivists. Increased patient care burdens can contribute to burnout (18), potentially leading intensivists to leave the field and further exacerbating the shortage. A recent survey of pulmonary/critical care fellowship directors revealed widespread concern that ICUs are often excessively large, negatively affecting patient care quality, training effectiveness, and workforce stability (19). Recognizing the severity of staffing challenges, SCCM developed guidelines to assist institutions in optimizing patient care and effectively utilizing intensivist resources (20). While technological advancements, advanced practice providers, and other interventions may improve ICU efficiency, they are unlikely to fully counteract the fundamental trend of an increasing number of critically ill patients requiring care from a limited pool of intensivists.
Given the multiple pathways to board certification in CCM, it is imperative to periodically reassess CCM training requirements. This ensures that standardized, competency-based goals are consistently met across all pathways. Program requirements play a crucial role in maintaining the quality of training and ensuring that graduates from diverse backgrounds possess the necessary skills and knowledge. However, when variations in requirements are not justified by differences in trainee backgrounds or curriculum needs, they must be carefully evaluated to avoid inadvertently creating barriers to program expansion, development, and trainee recruitment. Harmonizing these requirements is essential to strengthen the CCM workforce and ensure continued excellence in critical care delivery.
EDUCATIONAL PROCESS AND PROGRAM REQUIREMENTS FOR INTERNISTS SEEKING CCM CERTIFICATION
Internal medicine residents seeking CCM certification typically pursue one of two ACGME-approved training pathways after completing their IM residency. Pathway A involves completing 1 year of CCM fellowship after 2 years of accredited fellowship in an IM subspecialty (e.g., pulmonary, infectious disease, nephrology, or 3 years for cardiology and gastroenterology) (Table 1). Pathway B consists of 2 years of fellowship training specifically in CCM (Table 1) (1, 2. The ABIM also describes Pathway C, which includes 2 years of advanced general IM fellowship with at least 6 months of CCM experience during IM residency, followed by 1 year of CCM fellowship (Table 1) (2). However, ACGME-accredited advanced general internal medicine fellowships are currently unavailable. The ABIM is the certifying body for CCM fellowship-trained internists. Notably, emergency medicine board-eligible physicians can also train in IM-CCM fellowship programs, take the ABIM-CCM examination, and obtain CCM certification from the American Board of Emergency Medicine. However, a requirement that 75% of IM-CCM fellows (averaged over 5 years) must be graduates of ACGME-accredited IM programs effectively limits emergency medicine trainees to a maximum of 25% in any IM-CCM fellowship program.
Three-year PCCM programs represent the largest number of U.S. training programs leading to CCM board eligibility, followed by programs in surgery, anesthesiology, neurocritical care, and IM-CCM (21). PCCM fellowships significantly outnumber IM-CCM programs, with 138 programs offering 1,509 positions and graduating approximately 500 fellows annually, compared to 34 IM-CCM programs with 201 positions and roughly 100 graduates per year (21). This disparity highlights the need to examine the factors influencing the growth and accessibility of IM-CCM programs to address the intensivist workforce demands.
CURRENT CCM PROGRAM REQUIREMENTS
Critical care medicine addresses the needs of patients with severe and life-threatening conditions spanning medical, cardiac, neurological, and surgical specialties. Therefore, CCM training must provide fellows with diverse clinical experiences in the assessment and management of a wide spectrum of critically ill patients. This breadth of exposure is essential for developing well-rounded intensivists capable of handling the complexities of critical illness across different patient populations.
The total amount of clinical and critical care experience required for IM physicians pursuing CCM fellowships can vary based on their training background (Table 2). Both IM-CCM and PCCM trainees must complete at least 9 months of ICU experience, including a minimum of 6 months in a medical (MICU) or cardiac (CICU) intensive care unit, and 3 months in non-medical settings (e.g., trauma, surgical, neurological, transplant) (1). For those entering CCM programs from another IM fellowship (cardiology, infectious disease, or nephrology), up to 3 months of MICU or CICU experience gained during the subspecialty fellowship may be credited towards the 6-month MICU/CICU requirement of the CCM fellowship (2). The remaining time, as well as the second year of CCM training in Pathway B programs, can be allocated to additional clinical experience, research, quality improvement initiatives, scholarly activities, and completion of required clinical or academic experiences in related specialties.
For physicians pursuing dual certification, the minimum total full-time clinical training duration varies depending on the combined specialties: 18 months for CCM/pulmonary disease, 20 months for CCM/nephrology, 22 months for CCM/infectious disease, and 30 months for CCM/cardiovascular disease. The total training time remains at 4 years for CCM and cardiovascular disease or gastroenterology certification, and 3 years for CCM combined with any other IM subspecialty (2). These requirements reflect the need for comprehensive training to achieve competence in both critical care and the related subspecialty.
DIFFERENCES IN TRAINING REQUIREMENTS BETWEEN IM-CCM PROGRAMS AND OTHER SPECIALTIES
A comparative analysis of IM-based CCM pathways with anesthesiology and surgery CCM fellowships reveals significant differences in program requirements (Table 2). Notably, IM-CCM fellowships have unique program requirements that are not clearly justified by variations in pre-fellowship preparation or curriculum content (Table 3). These include mandates for additional ACGME-accredited IM subspecialty fellowships at the primary site, a specific minimum number of bronchoscopies for fellows, the exclusion of non-ABIM-certified intensivists as key clinical faculty (KCF), and more stringent KCF-to-fellow ratios (1).
Table 3.
Training Barriers for Internal Medicine-Critical Care Medicine Programs
| 1. | Requirement that at least 3 of 5 ACGME-accredited IM subspecialty fellowship training programs (cardiovascular disease, gastroenterology, infectious diseases, nephrology, or pulmonary disease) be located at the primary clinical site. This is one more subspecialty program than required by pulmonary-critical care medicine programs. |
|---|---|
| 2. | Exclusion of non-American Board of Internal Medicine critical care board-certified anesthesiologists and surgeons from key faculty status. |
| 3. | Higher key clinical faculty to fellow ratio in critical care medicine (1:1) programs with more than 3 fellows compared to a 1:1.5 ratio for other IM fellowships. |
| 4. | Restriction of fellows who have not trained in an ACGME IM program to no more than 25% of total fellowship positions per program, which limits the ability to train fellows from non-IM ACGME-approved programs (e.g., emergency medicine). |
| 5. | Requirement for non-pulmonary trainees to perform at least 50 therapeutic bronchoscopy procedures. |
Table 3: Key training barriers and unique ACGME program requirements specific to Internal Medicine-Critical Care Medicine fellowships.
Abbreviation: ACGME=Accreditation Council on Graduate Medical Education; IM=internal medicine.
While surgery- and anesthesia-based CCM fellowship programs require a core residency program on-site, they do not mandate the presence of fellowships. In contrast, IM-CCM and PCCM programs require at least 3 and 2 other IM subspecialty fellowship programs, respectively, at the primary training site (Table 2). This requirement may prevent otherwise qualified institutions, particularly those not affiliated with medical schools or lacking resources for multiple subspecialty fellowships, from establishing CCM fellowship programs. A survey of designated institutional officers and IM residency program directors identified this multiple fellowship requirement as the most significant barrier to initiating CCM fellowships (22). Despite the multidisciplinary nature of CCM practice, the task force found no empirical evidence suggesting that multiple on-site fellowships, as opposed to access to clinical expertise in these fields, are essential for an effective CCM fellowship program. Previous SCCM task forces on CCM training also did not identify multiple fellowships as a prerequisite for starting and maintaining a CCM fellowship program (23, 24).
IM-based CCM pathways also uniquely mandate a minimum number of bronchoscopies, the only procedure with a specified minimum requirement (1). Literature review revealed a single study (25 supporting the ACGME standard of 100 bronchoscopies during pulmonary fellowship training. This multicenter study demonstrated significant variability in bronchoscopy skills among pulmonary fellows even after 50 procedures, highlighting the variable learning curves and procedural volumes needed to achieve competence. The task force concluded that mandating a minimum number of procedures is not appropriate. Furthermore, while therapeutic bronchoscopy is valuable for intensivists, there is no evidence suggesting it is more critical or harder to learn than other core procedures like endotracheal intubation or tube thoracostomy, for which procedural volume competency is not specified. Consistent with the ACGME’s position that procedural competence assessment should involve formal evaluation (including simulation) and not solely rely on arbitrary procedure numbers (3), the task force advocates for further research to determine appropriate bronchoscopy training requirements for IM-CCM trainees (26–28). A recent systematic review of simulation-based bronchoscopy training (17 studies) indicated benefits for learner skills (e.g., airway inspection) and behaviors (time and process) compared to no intervention or alternative instruction (28). However, the review’s conclusions were limited by the quality and quantity of original studies, and the heterogeneity of simulation modalities, outcome measures, and trainee types.
Many IM-based CCM programs rely on faculty certified in surgery or anesthesia critical care, who contribute significantly to education in medical or mixed medical/surgical ICUs (22). However, only ABIM-certified faculty can serve as KCF for IM-CCM and PCCM pathways or supervise fellows in these ICUs. Consequently, if a PCCM or IM-CCM fellow rotates in a MICU or mixed ICU where a non-IM-trained intensivist is the attending, those training periods may not count towards the fellow’s medical critical care training. This ACGME requirement introduces complexities to KCF and ICU staffing and is inconsistent with the multidisciplinary nature of CCM.
Finally, IM-CCM programs face a more demanding KCF-to-fellow ratio compared to other IM-based fellowships, including PCCM fellowships (Table 2). PCCM programs require one KCF for every 1.5 fellows if there are over 9 fellows, whereas IM-CCM programs must have a 1:1 KCF-to-fellow ratio for programs with more than 3 fellows. This stricter requirement may limit the ability of existing programs to expand their fellowship class sizes. The task force found no evidence to support this more restrictive KCF-to-fellow ratio for IM-CCM programs.
COMPETENCY-BASED TRAINING FOR INTERNISTS
The ACGME and ABIM emphasize competency in six core areas for certification candidates: patient care and procedural skills, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice (1, 2). The task force strongly endorses competency-based medical education in CCM. They believe that graduates of all IM-based CCM programs should possess a consistent set of skills upon completing training, ensuring a uniform standard of care. Fellowship program directors and faculty bear the responsibility of providing education and training that produces competent and professional intensivists who meet the expectations of patients, families, hospitals, professional societies, and accrediting bodies. To achieve these goals, faculty evaluate fellows across the six core competencies and provide progressive supervision as fellows assume increasing responsibility for critically ill patient care. While the ABIM certification examination assesses medical knowledge, evaluating competency in other areas can be challenging. One effective approach involves defining the behaviors exhibited by competent and expert individuals within each competency and assessing the extent to which trainees demonstrate these behaviors. The ACGME’s Next Accreditation System educational milestones (29) are anticipated to further enhance the assessment and documentation of competence for all IM-based CCM trainees, promoting more robust and standardized competency evaluation.
RECOMMENDATIONS
Based on their analysis, the multisociety task force proposes the following recommendations to enhance and harmonize ACGME training requirements for all IM-based CCM fellowship programs:
- Harmonize Training Requirements: ACGME training requirements should be standardized across all IM-based CCM fellowship programs to ensure consistency and clarity.
- Eliminate Redundant Subspecialty Fellowship Requirement: The requirement for IM-CCM and PCCM programs to offer at least 3 of 5 ACGME-approved IM subspecialty fellowships at the primary clinical CCM training site lacks evidence support and should be removed unless proven to be a necessary component of CCM training.
- Include Non-IM Intensivists as Key Clinical Faculty: Board-certified intensivists with specialty training in anesthesiology and surgery should be eligible to serve as KCF for CCM fellowship programs based in IM and to supervise fellows in MICU settings. The ACGME should consider establishing a proportional limit for non-IM-trained KCF and allowable MICU teaching time to maintain the IM focus of these programs while leveraging diverse expertise.
- Standardize KCF-to-Fellow Ratio: The KCF-to-fellow ratio for all IM-based CCM fellowships should be standardized at 1:1.5, aligning with other IM fellowships and promoting program growth without compromising training quality.
- Eliminate Mandated Bronchoscopy Number: The requirement for IM-CCM trainees to perform 50 therapeutic bronchoscopies is not evidence-based for competency assessment or clinical training needs. This criterion should be eliminated, and bronchoscopic training needs and procedural competency should be determined through alternative assessment methods, potentially incorporating simulation and direct observation.
- Modify IM Graduate Ratio Requirement: The requirement that 75% of IM-CCM and PCCM fellows be graduates of ACGME-accredited IM programs should be modified to a 50% limit. This change would allow IM-CCM training programs to recruit highly qualified candidates from non-IM ACGME-approved programs, such as emergency medicine, enriching the diversity and skill sets within CCM fellowships.
CONCLUSIONS
While all IM-based CCM training pathways mandate one year of clinical CCM fellowship, variations exist between IM-CCM and PCCM programs, particularly in KCF-to-fellow ratios and the 50 therapeutic bronchoscopy requirement. The task force concluded that streamlining these variable training requirements for IM-based CCM programs and emphasizing competency-based training will enhance the effectiveness of CCM training for both programs and trainees. These recommendations aim to maintain the strong IM foundation of these training programs while recognizing the value of multidisciplinary training approaches in critical care medicine. By implementing these recommendations, the ACGME can foster a more unified, efficient, and high-quality educational landscape for IM physicians specializing in critical care, ultimately strengthening the intensivist workforce and improving patient care.
Acknowledgments
The task force extends gratitude to Ms. Sharon Plenner from SCCM for her administrative support throughout this project.
Copyright Form Disclosures: Dr. Pastores’ institution received grant support from Spectral Diagnostics and Bayer Healthcare. Dr. Martin served as a board member for Cumberland Pharmaceuticals and Pulsion Medical Systems and received research support from NIH. Dr. Baumann served as a board member for ACCP Board of Regents and received support for educational presentations and travel from ACCP and/or ATS. Dr. Curtis’ institution received grant support from NIH and PCORI. Dr. Fessler received support for educational presentations from Oakstone Medical Publishers and travel support from American Thoracic Society and the Association of Pulmonary and Critical Care Medicine Program Directors. Dr. O’Grady served as a board member for ABIM and is a government employee. Dr. Ognibene is a U.S. government employee. Dr. Simpson received travel support from the Surviving Sepsis Campaign and other support from the IMPRESS Study. His institution received grant support from the Kansas City Area Life Sciences Foundation.
Footnotes
The remaining authors have disclosed no potential conflicts of interest.
Prepared by: CCSC Task Force on Critical Care Educational Pathways in Internal Medicine
Contributor Information
Stephen M. Pastores, Memorial Sloan-Kettering Cancer Center, New York, NY.
Greg S. Martin, Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, GA.
Michael H. Baumann, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, MS.
J. Randall Curtis, Harborview Medical Center, University of Washington, Seattle, WA.
J. Christopher Farmer, Mayo Clinic Arizona, Phoenix, AZ.
Henry E. Fessler, Johns Hopkins University School of Medicine.
Rakesh Gupta, Orlando Health/Orlando Regional Medical Center, Orlando, FL.
Nicholas S. Hill, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, MA.
Robert C. Hyzy, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
Vladimir Kvetan, 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, New York.
Drew A. MacGregor, Wake Forest University Health Sciences.
Naomi P. O’Grady, National Institutes of Health, Bethesda, Maryland.
Frederick P. Ognibene, National Institutes of Health, Bethesda, Maryland.
Gordon D. Rubenfeld, Sunnybrook Health Sciences Centre Trauma, Emergency and Critical Care Program.
Curtis N. Sessler, 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, Aurora Health Care, and the University of Wisconsin School of Medicine and Public Health.
Steven Q. Simpson, Division of Pulmonary and Critical Care, University of Kansas, Kansas City, KS.
Antoinette Spevetz, Cooper Medical School of Rowan University Cooper University Hospital Camden, NJ.
Nicholas S. Ward, Division of Pulmonary, Critical Care, and Sleep Medicine Alpert Medical School of Brown University.
Janice L. Zimmerman, Professor of Clinical Medicine Weill Cornell Medical College Division Head, Critical Care Houston Methodist Hospital.
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