Specialty-specific knowledge as prerequisite for effective treatment of critically ill patients

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Since the last meeting of the German Medical Association in May 2024, there has been adiscussion in Germany about the shortening of primary specialty training and a transfer of the contents of additional supra-specialty training to the existing primary specialty training. This also affects intensive care medicine, with the prospect of creating asubspecialty for subspecialties in intensive care medicine (e.g., aspecialty in surgical intensive care medicine). We consider the associated reduction of general specialty-specific contents to be inappropriate for several reasons. Knowledge of the specialty-specific trigger factors (foci) of acritical illness (organ dysfunction) as well as knowledge of the respective trigger factor-specific symptoms, diagnostics and pathways for initiating a causal treatment, are decisive for the prognosis. Recent evidence suggests that in the case of septic foci a time span between making the diagnosis and treatment of the focus should not exceed ca. 6h in order to avoid aworsening of the prognosis. To ensure that the time between symptom onset and effective treatment of the causal factors is not too long, an in-depth expertise in the primary specialty is required throughout the process. This expertise is independent of training in intensive care medicine and can only be acquired through adequate training in the specialty, followed by additional training in intensive care medicine. Expertise in the primary specialty is aprerequisite for the effective treatment of critically ill patients. Maintaining the training specific to the primary specialty and the associated acquisition of specific knowledge in the respective specialty also enables awider deployment of specialists in clinical practice and amore economical use of diagnostic and therapeutic resources. The additional training in intensive care medicine (supraspecialty) should not be at the expense of content specific to the primary specialty and must remain accessible to all surgical specialties in the field of surgery in the next revision of the training regulations. Due to the unavoidable extent, the additional training in intensive care medicine can itself only be provided on afull-time basis.