© James Austin 2003
Last updated 9 May 2007
A few useful resources on the web - some of general medical interest and some ICU-specific, as well as info on Intensive Care exams in a few other countries. The three sites I would recommend the most are eMedicine.com for general reference; Advances in Sepsis for some excellent cutting-edge reviews; and Critically Appraised Topics for evidence-based critiques of some important ICU papers.
If you have any suggestions for other good sites or links, please send them to me at austin@dicm.co.uk .
PubMed: the free (thanks to Hilary Clinton!) Medline portal (in case you didn't already know).
Google Scholar: although it's increasingly touted as an alternative to PubMed, I don't think it competes (yet). It doesn't seem to have full access to Medline; and it only sorts by its own criteria of relevance, not by date. However, it may be useful for finding stuff that's not in conventional academic journals - so-called 'grey literature' - e.g. national guidelines, or government statistics. If you're interested, see this review of Google Scholar vs PubMed.
The Cochrane Library: a vast database of systematic reviews and meta-analyses. Abstracts can be accessed free, and many countries (including the UK) have made arrangements for free full-text access as well. The reviews are compiled by members of several different speciality Review Groups - most of the Cochrane reviews of ICU interest seem to have come from the Injuries Group.
eMedicine.com: a vast mishmash of useful resources - most useful are the up-to-date teaching reviews on a wide variety of topics, accessed via the search box. Many topics are duplicated by more than one speciality - so for example you can get the ENT view, the paediatrician's view and the emergency physician's view of epiglottitis. The review articles are well-structured and detailed, and it's like having an online reference textbook. Access is free, although you have to register; when you register, you can choose your speciality (e.g. critical care) such that the site will tailor itself to your interests, with a selection of links to journal articles from your speciality etc. You can also browse the 'ECG of the week', 'X-ray of the week', 'eponym of the day' etc., or choose to have these emailed to you.
Medscape: similar to eMedicine, but different. Focused far more on the postgraduate, their CME reviews tend to be more the sort you would find in a journal rather than in a textbook. They are much better than eMedicine at bringing 'newsy' items - research items that have reached Reuters, updates on medical conferences etc. A nice feature is their 'Ask an Expert' section, where you can submit a question and they will find someone authoritative to answer it for you; the resulting Q&A is then published for all to see. Most content is free, although again you have to register and again you can tailor the site to your speciality interest.
The Merck Manual: a straight online general medical textbook - nothing fancy, but free and very good! The Critical Care section is rather brief, but a useful general reference.
The Virtual Hospital: The University of Iowa's promising tour-de-force textbook has, alas, been allowed to lapse for lack of funding. While some of their content is still available, there is little of direct ICU interest.
Critical Care UK: This new site from John Griffiths and his team is packed with easy-to-read reviews of hot topics (32 so far - and counting?) targeted specifically at candidates for the DICM and FRCA. I thoroughly recommend it!
The Evidence-Based Medicine Group of the Scottish Intensive Care Society: Chris Cairns' site looks like a very promising resource both for DICM candidates and for clinicians in general. The site contains a quick introduction to the concepts of EBM, and evidence-based reviews of some key ICU topics.
PACT (Patient-centred Acute Care Training) (link fixed): This is the European Society of Intensive Care Medicine's distance-learning programme, aimed particularly (but not exclusively) at those planning to write the European Diploma in Intensive Care (see below). It is a work in progress, with over three quarters of the modules published so far. It looks as though it will be very good, but very expensive - access is by subscription only, with individual subscriptions going at 1000 Euros, or 800 Euros if you're a member of the ESICM or the (American) SCCM. There's not much of use here for those who don't want to shell out the cash.........
SCCM Resident ICU (RICU) course: This is the American answer to PACT. The good news is, it's free, even to non-USA trainees (you just have to register with your email address). The not-so-good-news? Well, it's not quite as comprehensive as PACT will eventually be, aimed at residents rather than fellows. The Adult ICU section consists of about two dozen Powerpoint presentations on core ICU topics, and a test MCQ exam. Buried amongst the links is a rather more comprehensive PICU section, with about three dozen Powerpoint presentations, but no exam.
Crit-IQ: This Australian site is pitched specifically at FJFICM candidates, and so far the exam-related content focuses specifically on written and OSCE-style papers, though a forthcoming section on Vivas has been promised. There is useful stuff on journal articles and critiques, some Powerpoint presentations, and some notes on data interpretation. Overall, a very promising site for the FJFICM, but probably less useful for DICM candidates.
Emcrit.org: Fast becoming an online textbook of intensive care - somebody has WAY too much time on his hands! Ostensibly aimed at Emergency Medicine practitioners, this site covers a vast number of practical ICU topics, in a laconic style, with frequent references.
Advances in sepsis: Excellent site from Remedica publishing, with some really top-notch up-to-date reviews ('leading articles') on trendy stuff in sepsis (e.g. toll-like receptors, genomics, new diagnostic markers), as well as good critiques ('clinical reviews') of recent key journal papers. Other features include reports on conferences, reviews of other websites, a SMARTbot that will email PubMed search results to you etc. Registration is free. They produce the same content in print journal form - I think you automatically receive this free when you sign up (it just started appearing in my postbox!).
sepsis.com: Eli Lilly's educational site for drotrecogin alpha has a very clear, well-explained animated slide show explaining the inflammation-coagulation interaction - with great prominence to the role of Protein C, of course. Other sections include treatment resources, a video of microcirculatory derangements in sepsis, a glossy PowerPoint presentation in case you ever have to do a talk on sepsis, and others. [links broken as of 5 May 2007 - I do hope they come back!]
ADQI: The Acute Dialysis Quality Initiative is a consensus forum looking not just at dialysis, but all aspects of acute renal failure. The Documents section presents summaries of existing evidence (although lack of evidence seems to be a recurring theme). They have made an admirable go of formulating consensus definitions to co-ordinate future research - time will tell how successful this will be.
ERC: the European Resuscitation Council homepage has the latest resuscitation guidelines, as well as teaching materials, info about ALS courses and links to other resources.
Critical Care Forum: serves as the site for the journal Critical Care, but also supplies news, conference reports etc. Some of the content is only available to paid subscribers, but you can sign up for free full access for one month.
CCCATS Library: Sadly most of the American Thoracic Society's critiques of important ICU papers seem to have disappeared. There's some consolation with a page of interesting critical care cases to work through.........
Resources for Practicing Evidence-based Medicine: This site, from Pediatric Critical Care Medicine and IntensiveCare.com, contains more links to EBM-related stuff than you can shake a meta-analysis at, but the fact that it's ICU-orientated is very helpful.
Evidence-based Decision Making: from the University of Sydney and the Royal North Shore Hospital, this is another excellent EBM site aimed at the intensive care physician. There is another journal club, with critical reviews of several important papers, crosslinked to the CHE Users' Guide to Evidence-based Practice; a steadily expanding set of graded evidence-based recommendations; and the interactive case simulations are quite fun for a bit of educational relaxation. The whole site positively invites interaction: you can submit your own reviews, comment on existing reviews, or suggest papers for others to review. (PS if the Javascripts don't run properly on the last three links, use the first link to the home page and then navigate to the relevant subsection).
Evidence-Based Critical Care Medicine: This site from the University of Toronto is particularly useful for its 'sample scenarios' - practical exercises in applying EBM techniques to real-life clinical problems.
ICNARC: the Intensive Care National Audit & Research Centre is a major player in ICM research in the UK - it's worth knowing something about what they do!
Classic Papers in Critical Care - this book, edited by Neil Soni and others, looks superb - useful for the DICM, though a bit dated now. I had been thinking of doing something similar myself, until I found he'd beaten me to it! Oh well - maybe I can be involved in the next edition...........
ABC of Intensive Care: the BMJ's series of articles on ICU. Some of it is a bit basic (and Chapter 12's 'cutting edge' has been blunted by the passage of years!), but it's core stuff to know for the exam.
Chapter 1: Organisation of intensive care
Chapter 2: Criteria for admission
Chapter 4: Respiratory support
Chapter 5: Circulatory support
Chapter 7: Neurological support
Chapter 8: Other supportive care
Chapter 9: Outcome data and scoring systems
Chapter 10: Withdrawal of treatment
Chapter 11: Recovery from intensive care
The Irish Diploma in Intensive Care Medicine (DICM RCP&S Irel): The entrance requirements to this exam are fairly similar to those for the UK DICM, in terms of training time and holding the Fellowship/Membership exam of your parent speciality. The exam itself looks rather different, with no dissertation or case reports required, but a mix of written (MCQ, SAQ and essay), clinical and viva components. There is a course aimed specifically at preparation for this exam.
The European Diploma in Intensive Care (EDIC): The entrance requirements are again similar to those for the UK DICM; you don't have to hold the Fellowship/Membership of your parent speciality, but "Awarding of the EDIC is dependent on the candidate completing ICM speciality training and also having completed his/her primary speciality training, e.g. in anaesthesiology or internal medicine". The exam itself consists of two parts. Part I is held at the annual European Congress on Intensive Care Medicine, and consists of 100 x 5 True/False MCQs. Part II must be done within 4 years of Part I and consists of a combination of clinical (i.e. bedside) and viva components. There is a move afoot to hold a second sitting each year, somewhere other than at the European Congress.
'The Australian Fellowship' (FJFICMANZ): Here Intensive Care is an entirely separate speciality, albeit with roots in anaesthesia. Training is administered by the Joint Faculty of Intensive Care Medicine (JFICM). Requirements include
An alternative route to the FJFICM, for those who have already completed Intensive Care Training and wish to live and work in Australia, is via assessment as an Overseas-Trained Specialist (OTS). Application is made via the Australian Medical Council (AMC), with a tremendous amount of paperwork. The AMC refers such applications to the JFICM, which will compare your training and qualifications to those of Australasian trainees. The JFICM will usually require that you spend a year or two in 'supervised practice' in Australia, and may require you to sit their exam as well (without going through the requirements listed above). Once you have satisfied them that your training and qualifications are equivalent, you may be recognised as a specialist; though you can only become a FJFICM if you sit the exam.
A similar system operates in New Zealand via the MCNZ. However, it is somewhat easier to work as an intensivist without having the FJFICM in New Zealand than in Australia, particularly in the district hospitals.