The Critical Care Specialty Board System in Korea

First, Do No Harm: Less Training ≠ Quality Care

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Fifty Years of Critical Care Medicine: The Editors' Perspective.

Critical care is an expensive and limited resource in the United States. Estimates from more than a decade ago suggest that over $100 billion a year is spent on critical care services.1 Over the past two decades, the number of patients presenting to the Emergency Department (ED) requiring critical care services has increased at a much higher rate than the growth in overall ED volume.2,3 The proportion of ED patients requiring Intensive Care Unit (ICU) admission has increased 75% over the first decade of the twenty-first century. In addition to the increase in the absolute number of patients requiring critical care admission, the ED length of stay for critically ill patients increased by 60 minutes. This resulted in a total nationwide increase in critical care provided in the ED by more than threefold. This disproportionate increase in critical care time reflects both the increase in critical care volume and the increase in ED boarding of critically ill patients. Data from 2008 reported the median boarding time for a patient waiting in the ED for an ICU bed was more than 5 hours, and 30% of patients waited more than 6 hours for an ICU bed.2,3 This article is protected by copyright. All rights reserved.

Critical Care During the Coronavirus Crisis—Reflections on the Roles of Anesthesiologists in Meeting the Challenges of the Pandemic

Lessons Learned From Web- and Social Media-Based Educational Initiatives by Pulmonary, Critical Care, and Sleep Societies

The goal of critical care is to reverse patients’ acute problems in effective and ethical ways with minimum costs. Unlike in other medical fields, the quality of Korean critical care has lagged behind that of advanced countries. Moreover, the level of critical care quality differs significantly between university hospitals. The suboptimal critical care level has multifactorial causes. The major challenge to Korean intensivists is, therefore, how to overcome barriers in the current critical care delivery system to improve outcomes for critically ill patients and reduce medical errors in error-prone Intensive Care Unit (ICUs). A long-term task force including all stakeholders should address the multifactorial barriers to better outcomes. The Korean Society of Critical Care Medicine should perform the central role to dismantle the barriers step by step with a long-term vision for a desirable critical care delivery system in our society. A capable critical care team with full-time intensivists is the most urgent requirement for proper, timely care in ICUs. Intensivists should focus on basic but essential management so scarcity of resources can be minimized. Publicity about ICU to the general public is also urgently required to draw the attention of medical policy makers to the current suboptimal level of our critical care system.

In the United States, physician training in Critical Care Medicine has developed as a subspecialty of different primary boards, despite significant commonality in knowledge and skills. The Society of Critical Care Medicine appointed a multidisciplinary Task Force to examine alternative approaches for future training. The Task Force reviewed the literature and conducted informal discussions with key stakeholders. Specific topics reviewed included the history of critical care training, commonalities among subspecialties, developments since a similar review in 2004, international experience, quality patient care, and financial and workforce issues. The Task Force believes that options for future training include establishment of a 1) primary specialty of critical care; 2) unified fellowship and certification process; or 3) unified certification process with separate fellowship programs within the current specialties versus 4) maintaining multiple specialty-based fellowship programs and certification processes. 1) Changing the current Critical Care Medicine training paradigms may benefit trainees and patient care. 2) Multiple pathways into critical care training for all interested trainees are desirable for meeting future intensivist workforce demands. 3) The current subspecialties within separate boards are not "distinct and well-defined field[s] of medical practice" per the American Board of Medical Specialties. Recommendations for first steps are as follows: 1) as the society representing multidisciplinary critical care, the Society of Critical Care Medicine has an opportunity to organize a meeting of all stakeholders to discuss the issues regarding Critical Care Medicine training and consider cooperative approaches for the future. 2) A common Critical Care Medicine examination, possibly with a small percentage of base-specialty-specific questions, should be considered. 3) Institutions with multiple Critical Care Medicine fellowship programs should consider developing joint, multidisciplinary training curricula. 4) The boards that offer Critical Care Medicine examinations, along with national critical care societies, should consider ways to shorten training time.

Surviving Sepsis Campaign.

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As early as August 1974, "organ failure resuscitation ward" for critically ill patients with cardiac, respiratory or renal failure had appeared as independent medical units in China. In 1980s, the discipline of critical care medicine had experienced a rapid development, shown its superiority in both daily health care and public health emergency, also its status in the academy of medicine. On September 4th, 1989, the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) accepted the Chinese Association of Integrative Medicine, Society of Critical Care Medicine (TCMWMCSCCM) as an official member. In November 1989, the former State Scientific and Technological Commission approved the establishment of Critical Care Medicine in Tianjin, the first journal in the very field in China, indicating that Chinese critical care medicine has been officially accepted by the international academia and its academic status has been determined. In September 1997, the Chinese Association of Pathophysiology organized the Chinese Society of Critical Care Medicine. In March 2005, the Chinese Medical Association organized the Chinese Society of Critical Care Medicine had found. In July 2009, Chinese Association of Critical Care Physicians had found under the Chinese Medical Doctor Association. In 2008, Critical Care Medicine had been defined as secondary clinical discipline (Subject code 320.58) by Standardization Administration of the People's Republic of China. In 2009, it was listed in the first clinical discipline (Code 28). In 2001, Chinese Society of Critical Care Medicine under the Chinese Association of Pathophysiology had officially joined the WFSICCM and the Asia Pacific Association of Critical Care Medicine (APACCM), and became a member in both councils. Between 2006 and 2010, Chinese Society of Critical Care Medicine under the Chinese Association of Pathophysiology had become the presidency and member in APACCM, WFSICCM and Global Sepsis Alliance (GSA), respectively. So far, there are a number of critical care physicians from China serve as a member in international academic organizations. In ESICM LIVES 2012, held in Lisbon, Portugal, the Chinese Society of Critical Care Medicine under the Chinese Association of Pathophysiology was invited on behalf of China and gave lectures, showing the elegant demeanor of Chinese scholars. Since 2013, the Annual Congress of Chinese Society of Critical Care Medicine has set up the China-USA Joint forum and China-Europe forum. In 2018, the Chinese Society of Critical Care Medicine started a series of "Belt and Road" academic activities, signed the cooperation agreement with 18 academic community of critical care medicine from respective countries or districts along the Belt and Road, and established a long-term relation of communication and cooperation, indicating that Chinese critical care medicine has intensively participated in international communication and integration. Year 2019 is the 40th year of Chinese construction and development in critical care medicine. Today, Chinese critical care medicine is taking off. It has developed rapidly on a brand-new level, advanced on the highway of professional and standardized development, achieved a series of development and won the praise of peers around the world. Since the establishment of Chinese Society of Critical Care Medicine in March 2005, the scale of annual congresses has expanded year by year, participants increased from mere 1 000 to more than 15 000, contributions increased from hundreds to thousands, exhibiting the prosperity of Chinese critical care medicine. Meanwhile, the society has published guideline series, technical specifications and academic yearbooks, implemented Chinese Critical Care Certified Course (5C training), carried out the continue education program and grassroot education activities, set up the "lifetime achievement award", etc., to promote continuous progress and development in Chinese critical care medicine. The Chinese Association of Critical Care Physicians has greatly contributed to the promotion in critical care specialist training, also push forward the progress. In August 2018, department of critical care medicine was selected in the second batch of standardized training bases for specialists, and began recruitment in both medical and surgical critical care medicine in March 2019. The future of Chinese critical care medicine requires us to make clear the developmental blueprint of the discipline, to persevere with integration and innovation, and to meet the needs of society. Efficient and normative systems are also required in the discipline construction, talent cultivation, diagnosis and treatment system, academic construction, and intelligent application of network data. Particularly, we should vigorously carry out and promote the homogenization of critical care specialist training for talent resources reservation. We should actively promote the establishment of clinical research platforms for critical care medicine, encourage and support multicenter clinical researches. We should promote multi-channel communication in the field at home and abroad, expand the international influence of Chinese critical care medicine step by step, to promote the sustainable development of Chinese critical care medicine, to explore further forefront of modern medicine, to promote greater contribution to human health.

A consistent feature of discussions of health care reform has been the assertion that there is an oversupply of specialists.' Although there is some data that address the issue of physician workforce,2 there is not universal agreement as to how the information should be interpreted and acted upon.3'4 Given these uncertainties and the need to chart a clear course for training in critical care medicine and in pulmonology that is consistent with the anticipated needs for specialists in these areas, accurate data on which to base projections are essential. Therefore, on January 16 to 17, 1995, the American Thoracic Society, American College of Chest Physicians, Society of Critical Care Medicine, and the Association of Pulmonary/Critical Care Training Program Directors met to discuss future needs for training in pulmonary and critical care medicine. In addition to representatives of each society, the meeting was also attended by representatives of the American Board of Internal Medicine (ABIM), individuals who have performed studies of workforce needs for other subspecialties, and physicians who have conducted prior studies of workforce needs in pulmonary and critical care medicine. The workshop addressed two concerns: (1) workforce needs (numbers of trainees) and (2) quality of training. These two areas have not been addressed for a significant period of time by societies with a specific interest in either pulmonary or critical care medicine. The rapid changes in healthcare delivery and the implications of these changes for training were additional stimuli to hold this meeting. Although each society could develop its own recommendations for training, it was believed that *From the American Thoracic Society (Dr. Hunninghake, president); the American College of Chest Physicians (Dr. Mark, president); the Society of Critical Care Medicine (Dr. Rainey, president); and the Association of Pulmonary/Critical Care Training Program Directors (Dr. Fish, president). This article has also appeared by prior agreement in the official journals of the American Thoracic Society and the Society of Critical Care Medicine and is a joint report on the meeting of the ACCP, ATS, SCCM, and APCCTPD, January 16-17 at ACCP National Headquarters in Northbrook, Illinois, at which issues relating to this article's topic were discussed. these recommendations would not be as effective as recommendations that were endorsed by all societies with an interest in pulmonary and critical care training. The importance of joint recommendations was reinforced in a discussion by Dr. Harry Kimball, president of the ABIM, who also noted that it was the responsibilities of the societies interested in pulmonary and critical care to address these issues. He further noted that recommendations coming from these groups would be very influential in developing policy. It was acknowledged that critical care, as a discipline, is unique compared with other internal medicine areas in that it is practiced by noninternal medicine physicians, eg, surgeons, anesthesiologists, and pediatricians. In addition, although most of the internal medicine physicians who practice critical care are also trained in pulmonary medicine, other internal medicine subspecialists as well as general internists are trained and certified in critical care medicine. Finally, the practice of critical care crosses traditional boundaries, eg, internal medicine-based critical care physicians often work in surgical or mixed medical-surgical ICUs.

The Critical Care Professional Societies Address the Critical Care Crisis in the United States

PICU Readmissions: Not Just Output but Patient Throughput*