key: cord-0800274-3tm5hx6f
authors: Cecconi, Maurizio; Kesecioglu, Jozef; Azoulay, Elie
title: Diversity and inclusivity: the way to multidisciplinary intensive care medicine in Europe
date: 2021-04-29
journal: Intensive Care Med
DOI: 10.1007/s00134-021-06384-4
sha: 79d7f7ed55532047b9e47da29a046d15bcd55b03
doc_id: 800274
cord_uid: 3tm5hx6f

nan

Despite Europe being the place where the specialty was born and having a long tradition of clinical, research and educational excellence in intensive care medicine (ICM), Intensive Care Medicine does not exist as a European professional qualification in Annex V of the Directive 2005/36/EC. It results in part from the different pathways to become an intensivist: different base specialties (anaesthesiology, internal medicine, respiratory medicine, cardiology, neurology, nephrology, surgery, etc.) lead to Critical Care. In some countries, Critical Care is a primary specialty. The European Society of Intensive Care Medicine (ESICM) believes that this diversity has widened the discipline in Europe. Unfortunately, this has also prevented the free movement of intensivists across Europe, allowing only mutual recognition of base specialties. Inability to transfer skilled intensive care specialists is a major weakness for European citizens and intensivists, particularly for the next generation of intensivists.

In November 2020, ESICM contributed a draft consultation paper to include Intensive Care Medicine in Annex V, creating a framework to unfetter intensivist's movements. This paper was shared with the European Commission, that started a preliminary fact-finding mission with a consultation of Member States of the EU. We are grateful to the national and international societies from various disciplines, which have provided feedback on the intensivists' free movement based on diversity and multidisciplinarity. Our proposed framework for Annex V considers existing training pathways to becoming a European intensivist and, if applied, will allow intensivists to work across different countries. Every respondent has made it very clear that what matters the most is that intensivists *Correspondence: president@esicm.org Recognizing ICM as a specialty, keeping existing specialties and give value and recognition multidisciplinarity and inclusiveness are the fundamental values to achieve this.

Framing a proposal that stands between the lowest common denominator and the patient's best interest and healthcare workers working conditions.

Easing the circulation of intensive care specialists in Europe by standardizing training modalities in quantity and quality (competencies, credentials).

Including all schemes, modalities and intensive care curricula throughout Europe without making one of those the standard. We should learn from each model. This initiative promotes competencies. These competencies should be acquired in an adequate amount of time, both in a primary specialty or in one of the multidisciplinary pathways.

. Building a European Health Union dedicated to intensive care. We are committed to shaping the future of critical care in a way that can serve individual and public health, much more than owns (or anyone's) interests. This union will have to address the EU's health security framework and reinforce preparedness and response to the current health crisis and future ones*. We need to take advantage of the high degree of solidarity within the EU Member States throughout and beyond this pandemic. Following the pandemic emergency, we need to rebuild based on what we learned, shape the future of intensive care, and protect the next generations. The time is now to think innovatively. A pragmatic and functional European Health Union is mandatory to respond to pandemics and disasters. As critical care clinicians, we are concerned about patient's outcomes. European citizens share these concerns and expect safeguards from a single voice, rallied actions, and effective results.

As ESICM, we are committed to optimizing the existing situation.

Together we are Intensive Care. Together we have a unique opportunity to acknowledge the importance of ICM for our healthcare systems and to find a structured, flexible and long-term solution to this issue urgently. This solidarity will have to build the safest possible model for patients and providers. We must rebuild European citizens' trust by offering the best possible healthcare service. People count on us; we cannot miss this opportunity. Facilitating intensivists' free movement across EU countries has been advocated for a long time by ESICM. This initiative allows ICU specialists to freely operate within the EU, sharing knowledge and competences, ultimately improving care standards. ESICM believes that the Intensive Care Medicine's inclusion using a "novel approach" to Annex V of the Directive on the Recognition of Professional Qualifications (2005/36/ EC) will represent significant progress towards the rapid recognition of these essential healthcare professionals [7] .

In summary the European Society of Intensive Care Medicine • Is aware that it will be a long journey to heal our healthcare systems and economies. However, we cannot wait longer to address the medical community's warning signals about the lack of beds and trained specialists. Suboptimal intensive care is associated with adverse outcomes, healthcare workers exhaustion, and professional leave [8] . • Will continue promoting a multidisciplinary, diverse, and inclusive ICM vision (Fig. 1) . ESICM is convinced that the variety of base specialties can only widen and improve intensive care delivery. • Urges for the free movement of ICU specialist inside Europe (in times of crisis or as a personal choice). • Urges for the recognition of ICM as an entire profession in the European directive (2005/36/UE annex V) • Advocates that, whatever pathway, i.e., a primary specialty or a subspecialty of 2 years of Intensive care training (within, on top or across the base specialty), everyone, as long as competencies are achieved, should be recognized a European Intensivist. • ESICM advocates that European Intensivists should be able to work in different countries as long as the competencies have been achieved.

The free movement of Intensivists in Europe is something we owe to European Citizens and Intensivists in Europe. Diversity and inclusivity are the two values that needs to guide the path to multidisciplinary ICM in Europe.

The outbreak that invented intensive care

The variability of critical care bed numbers in Europe

How the COVID-19 pandemic will change the future of critical care

Models for intensive care training. A European perspective

International standards for programmes of training in intensive care medicine in Europe

The educational environment for training in intensive care medicine: structures, processes, outcomes and challenges in the European region

Educational process. Recommendations and standard operating procedures for intensive care unit and hospital preparations for an influenza epidemic or mass disaster

The inner life of physicians and care of the seriously ill

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Received: 11 March 2021 Accepted: 12 March 2021