sábado, 9 de julio de 2011

Development of the faculty of intensive care medicine.

Vale la pena leer la editorial del BJA acerca de los intensivos en UK (Nightingale P. Development of the faculty of intensive care medicine. Br J Anaesth. 2011;107: 5-7) porque contiene informacion relevante para la medicina de cuidados intensivos.
En concreto el Dr. Nightingale afirma lo siguiente:

1. Que aunque los intensivos es parte necesaria de la formación de un anestesista no todos quieren dedicarse a ello, como es conocido:

It was reiterated frequently that all anaesthetists need critical care skills and this will always be so. Training in ICM is done over 9 months in a pattern of ?spiral learning? to a higher level than any other specialty. However, it is accepted that although anaesthetists may need critical care skills when caring for patients in the Operating Theatre and Emergency Department, not all will wish to deliver continuing care to critically ill patients within the intensive care unit (ICU). This ongoing responsibility is accepted by those consultants who wish to dedicate a significant part of their working week to the ICU, and requires a different training over and above that obtained by all anaesthetists.

2. Que la Medicina de Cuidados Intensivos debe mantenerse de acceso multidisciplinar:

In the 14 years, it has been in place the Intercollegiate Board has exemplified the wish of intensivists to be part of a multidisciplinary training programme; that desire has seen it through a number of difficulties over the years. The Board has been hugely successful in bringing together those, from whatever background, who wish to raise the standard of training and practise within the specialty. The wisdom and foresight of those who saw that the specialty will essentially remain multidisciplinary are to be congratulated.

3. Que lo óptimo es que los intensivistas tengan una especialidad primaria que les permita un trabajo distinto de la UCI:

It is the general expectation that most contemplating a career in ICM will choose Dual CCTs, predominantly with anaesthesia. As in many parts of the world, medical training and workforce development remains problematical. The current Coalition Government in England, in the face of a severe financial crisis, is consulting on how medical careers will be structured in the future. It is likely that consultants will be expected to deliver more service directly and, at the same time, be expected to work past the age of 65. Although ?burnout? is less of a problem than previously, it remains a worry for intensivists. Many consider that trainees should have skills in another specialty (e.g. anaesthesia) where their workload can be adjusted in later years.

4. La mayoría de los intensivistas serán siempre anestesistas:

The Royal College of Anaesthetists can be proud of its vision and support of those who have laboured to improve the care that patients can expect when admitted to an ICU. By developing a career structure with a specific training and assessment programme, ICUs will more and more be staffed by consultants who want to be there. Most of them will be anaesthetists.

Me parece que es una editorial muy positiva que demuestra las discrepancias importantes entre lo que sucede en  UK y en España.

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