TEACHING CRITICAL CARE IN EUROPE - ANALYSIS OF A SURVEY

Objective: To analyze the status of the teaching of critical care at t he postgraduate and undergraduate levels in Europe. Data Sources: Two types of questionnaires were sent in order to collect data. The first questionnaire was sent to the heads of the intensive care units (ICUs) of at least five of the major hospitals In each western country of th e European Region of the World Health Organization and to the people r esponsible for specialist training in the Eastern countries. Countries in the former USSR and former Yugoslavia were excluded; 50 questionna ires (of 105) were returned. The second questionnaire was sent to the 374 medical schools in the European Region; 253 were returned although only 185 were selected for this article. Results: Postgraduate and un dergraduate training differ widely in terms of the content of, and dis ciplines in charge of, the teaching of critical care. Even countries o f the World Health Organization's European Region, where critical care is a recognized clinical specialty, do not have an academic disciplin e of critical care. This lack of an established academic discipline of critical care contributes to the diversity in teaching critical care in medical schools in the countries we studied. Postgraduate training is more formally regulated, and objectives and guidelines have been es tablished in many countries. The topics in medical schools that corres pond to critical care medicine do not encompass a distinct body of kno wledge and are distributed among more traditional disciplines, most fr equently internal medicine, anesthesiology, and surgery. The critical care medicine experience afforded to undergraduates varies widely betw een and within countries. The repetition of critical care conditions f or which patients receive critical care in several disciplines, as des cribed by the responses, leads us to wonder whether these conditions a re really included in the curriculum. Conclusions: The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and j udgment necessary to practice) in medical schools, and better coordina ted postgraduate training are needed to clarify an educational approac h in the field. Practitioners of critical care medicine will have to p articipate actively on curriculum committees, The recognition of criti cal care medicine as a specialty or subspecialty and as an academic di scipline will facilitate the achievement of a comprehensive critical c are education program.