lunes, 9 de julio de 2012

Comment on Rubulotta et al.: Intensive care medicine: finding its way in the “European labyrinth”


Comment on Rubulotta et al.: Intensive care medicine: finding its way in the “European labyrinth”

Hugo Van Aken1, Benoît Vallet2 and Jannicke Mellin-Olsen3, 4

We read with interest the Special Article by Rubulotta et al. [1] on the development and future of intensive care medicine (ICM) in Europe. In our view, some of the statements made in the article need clarification.

Although we agree that there is wide variability in the duration, quality, and consistency of training, which impedes free movement of specialists between European countries, this has never been shown to have a negative impact on the outcome, quality, or effectiveness of care. The Multidisciplinary Joint Committee in Intensive Care Medicine (MJCICM) was created ‘to harmonise training programmes and achieve minimum standards of training and expertise among the member European Union states’ [2]. It was not created with the aim of facilitating the recognition of ICM as a primary speciality. An important reason why harmonisation is desirable is to ensure the quality, safety, and effectiveness of care. In addition, it should facilitate the free movement of specialists among European countries.

This goal can be achieved by harmonising the acquisition of competencies through the Competency-Based Training in Intensive Care Education (CoBaTrICE) programme, and by evaluation at the end of training the competences through a formal examination. The aim of the CoBaTrICE is to optimise care for the critically ill patient by developing common standards of training, independently of the primary speciality.

The MJCICM therefore unanimously decided to request that the European authorities should incorporate ICM as a ‘particular qualification’ in the revision of European Directive 2005/36/EC in 2012. A “particular qualification” is an area of expertise in addition to a primary speciality qualification in which extra expertise outside the domain of the primary speciality is required to provide high-quality patient care.

The MJCICM has always clearly pleaded for multidisciplinary access to ICM and does not support the idea of ICM becoming a primary speciality. Instead, ICM should be as a particular qualification open to all specialities involved in ICM, as it is already the case in many European countries [3]. Primary speciality status for the discipline, which currently exists in Spain and the UK (UK), is neither necessary nor desirable. In the UK, however, a dual pathway is possible; this means that a qualification in ICM can be obtained either as a primary speciality or as a particular qualification on top of another primary speciality (e.g., anaesthesiology, surgery, or internal medicine).

The reasons for this are clear and obvious: firstly, ICM appears to be too complex to be covered by a single medical speciality alone; secondly, separating ICM as a primary speciality would tend to impede mutual communication and collaboration among different professionals with specific knowledge, expertise, and skills; and thirdly, ICM is extremely demanding physically and mentally. Establishing ICM as a primary speciality would disqualify intensivists from working in another specialisation, whereas the ‘particular qualification’ approach allows them to return to their ‘mother disciplines’, rotate back there for a period or allow those working in the mother discipline to participate in the on call system.

All parties involved in ICM in European countries should seek an open-minded discussion with the aim of harmonising the required competencies in order to develop ICM and achieve better treatment and safety for future patients in intensive care.



1. Rubulotta F, Moreno R, Rhodes A (2011) Intensive care medicine: finding its way in the “European labyrinth”. Intensive Care Med 37:1907–1912. doi:10.1007/s00134-011-2391-1

2. De Lange S, Van Aken H, Burchardi H; European Society of Intensive Care Medicine; Multidisciplinary Joint Committee of Intensive Care Medicine of the European Union of Medical Specialists (2002) European society of intensive care medicine statement: intensive care medicine in Europe—structure, organisation and training guidelines of the multidisciplinary joint committee of intensive care medicine (MJCICM) of the European union of medical specialists (UEMS). Intensive Care Med 28:1505–1511

3. Van Aken H, Mellin-Olsen J, Pelosi P (2011) Intensive care medicine: a multidisciplinary approach! Eur J Anaesthesiol 28:313–315

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