© James Austin 2003
Last updated 13 June 2011
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. If you have any suggestions for other good sites or links, please send them to me at firstname.lastname@example.org .
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: now subsumed into Medscape, eMedicine contains 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 or via the Critical Care collection. 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: apart from eMedicine, Medscape contains a wide range of other content. They are superb at bringing 'newsy' items - research items that have reached Reuters, updates on medical conferences etc. Short webcasts from experts provide opinions on current hot topics. 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. Their content (including eMedicine) can also be accessed via a free app for iPhone/iPad, Android or Blackberry.
Uptodate.com: Uptodate.com has fast established itself as one of the leading sites for - literally - up-to-date review articles, priding themselves on rapidly incorporating new research into their reviews. They have quite a comprehensive critical care section. The downside is that they are quite expensive, at US$495 per year for a subscription; though trainees get a discount at US$195, or you may be able to persuade your institutional library to take out an institutional subscription.
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.
Critical Care UK: This 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 is a great resource both for DICM candidates and for clinicians in general. The site contains an introduction to the concepts of EBM, and evidence-based reviews of some key ICU topics; as well as a description of and access to CATmaker, a software programme for Critically Appraised Topics.
PACT (Patient-centred Acute Care Training): 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 contains in-depth tutorials, with references and self-test True-False questions, covering (at time of writing) 44 core ICM topics. The price has come down considerably - it is now free to ESICM members (ESICM subscription is €185 per year, or €100 if you are a trainee, or if you already belong to the ICS, ANZICS or similar society); or you can pay €395 for stand-alone access (but why would you?).
SCCM Resident ICU (RICU) course (link fixed): This is the American answer to PACT, with about 36 Adult ICU modules and 41 PICU modules, available as online presentations or downloadable PowerPoint or PDF handouts. The good news is, it's free, even to non-USA trainees - you can view the presentations without registering at all, or register (free) to access online self-tests and a diary to track which modules you've worked through. From modest beginnings, it has rapidly grown to rival PACT, and is thoroughly recommended.
Crit-IQ: This Australian site is pitched specifically at FCICM candidates, with exam-related content focusing specifically on written papers, vivas and hot cases, as well as an exam preparation blog. There is also useful stuff on journal articles and critiques, some Powerpoint presentations, and some notes on data interpretation. A regular email newsletter goes out, flagging up the latest hot publications in the journals. Overall, an essential site for FCICM candidates, but probably slightly less useful for DICM candidates.
Emcrit.org (link fixed): 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 podcasts and videos. Not particularly organised or systematic, but a mine of useful information!
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!).
ADQI: The Acute Dialysis Quality Initiative is a consensus forum looking not just at dialysis, but all aspects of acute renal failure. 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.
ATS Critical Care Section: Sadly most of the American Thoracic Society's CCCATS critiques of important ICU papers seem to have disappeared. There's some consolation with a page of interesting critical care cases, and a few clinical education topics, 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 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 3: Organ dysfunction
Chapter 4: Respiratory support
Chapter 5: Circulatory support
Chapter 6: Renal 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
Chapter 12: Cutting edge
The Diploma of the Irish Board of Intensive Care Medicine (DIBICM): 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, that may also be of use to DICM or EDIC candidates.
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 (a second venue is now available - Bern in Switzerland for 2011), 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.
The Australian Fellowship (FCICM): Here Intensive Care is an entirely separate speciality, albeit with links to anaesthesia and to the physicians. Training is now administered by the new College of Intensive Care Medicine (CICM), which has replaced the Joint Faculty of Intensive Care Medicine (JFICM). Requirements include
An alternative route to the FCICM, 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 CICM, which will compare your training and qualifications to those of Australasian trainees. The CICM 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 FCICM 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 FCICM in New Zealand than in Australia, particularly in the district hospitals.