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Important message from the ESICM president and president-elect

Dear members and friends of the ICM community,

The current pandemic has brought a large number of patients needing intensive care to our hospitals. As intensivists, we have been looking after a very large number of patients in ICUs and have worked with nurses, allied health professionals and physicians from other specialities. This has meant major adaptation of the organisation of hospitals and ICUs, and enormous efforts for all the staff involved, both physical and mental.

First of all, we wish to thank all these colleagues. Secondly, this has reminded us of the importance of our multidisciplinary background. As the European Society of Intensive Care Medicine, we have provided leadership from the beginning of this pandemic, and have kept our community united.

This is indeed a time for solidarity and a time for trust, with the only mission being the care of our critically ill patients.

In modern intensive care, as specially-trained intensivists, we carry the responsibility of patient care and decision-making. ICUs are increasingly important departments in hospitals, in terms of resource and as a proportion of bed stock.

In many countries, doctors acquire extra training in addition to their base speciality to become intensivists, and in some countries, Intensive Care Medicine is a base speciality. What matters is that during the training, physicians acquire enough competencies with enough time to practice multidisciplinary Intensive Care Medicine.

Patient outcomes are shown to be better when patients are cared for by trained intensivists. Although intensivists may have different base specialities and fields of interest, they have to maintain a generalist approach in order to exercise a broad range of skills, knowledge and the competencies needed to treat the patient as a whole.

The European Society of Intensive Care Medicine (ESICM) defined, more than one decade ago, the international competency-based training programme in Intensive Care Medicine (CoBaTriCE), which was approved by the European Union of Medical Specialists (UEMS) Council.

The competencies and knowledge of trained intensivists have increased dramatically during the last decades. Maintaining ventilation and circulation and just waiting for the patient to get better is a thing of the past. Intensivists routinely perform CVVH, ultrasound, ECMO, bronchoscopy, feeding, antibiotics and many other treatments in their daily practice. Next to physical wellbeing, is a growing insight into the mental wellbeing of the patients and their families, and the long-term outcomes.

Many of the critically ill COVID-19 patients we have admitted to our ICUs present wide-ranging and complex problems, such as respiratory, renal, cardiac, haematologic and nosocomial infections. All these demand specialist knowledge and competencies, which, as intensive care professionals, we possess.

Intensive Care Medicine has become a unique profession, transcending a number of other specialisms. Being an intensivist is not just about the title, it is more about competencies. At present, no other speciality should consider itself to be “naturally competent” to carry out the responsibilities of an Intensive Care Unit, unless competencies and the time to acquire them are part of their curriculum. No basic speciality should claim natural competencies.

Intensive Care Units with a multidisciplinary character, as mentioned above, need staff members who may be composed of different specialities. Intensive Care Medicine is complex and the close co-operation of intensivists from various backgrounds improves the quality of care for the critically ill.

The free movement of intensivists across European countries is an important issue. A medical specialist from a European country can move to another, with his/her diploma being automatically accepted. Today, the lack of homogenous training and education to become an intensivist is preventing this movement. An intensivist from one European country often needs to have extra training to be registered in another, due to different training requirements.

The leadership to promote shared competencies between other specialties and the free movement of intensivists exists within our Society. We have exercised this leadership and carry on doing so by being inclusive, and in collaboration with other Societies that represent base specialities for Intensive Care.

We are aware that the European Society of Anaesthesiology (ESA) has recently circulated a letter to its members proposing to change its name to include Intensive Care. This proposal should not be wrongly perceived as though ESICM has been consulted, or has agreed to this. Many of us, including our President and President-elect, are anaesthesiologists and intensivists. We are confident that all the anaesthesiologists working in intensive care that we represent know that they have acquired the competencies to care for critically ill patients. A title should follow competencies, not vice versa.

Intensive Care Medicine is what ESICM stands for. Let us stay united in approach, be proud of our speciality and what we represent, and to use the platform of our Society to represent the intensive care professionals working so relentlessly and courageously all across the globe, to save lives.

Together, we are Intensive Care Medicine.

Yours respectfully,

Prof. Jozef Kesecioglu, ESICM President
Prof. Maurizio Cecconi, ESICM President-elect

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