FEATURE ARTICLE
Determination of Adult Critical Care Physician Core Knowledge and Skills: Results of a Multidisciplinary, Modified Delphi Process
Tisherman, Samuel A; Spevetz, Antoinette; Farmer, J. Christopher, et al
Critical Care Medicine 54(2):p 224-233, February 2026. | DOI: 10.1097/CCM.0000000000006978
Abstract
Objectives:
In the United States, training for physicians who manage critically ill adult patients (intensivists) evolved through parallel subspecialty critical care medicine (CCM) pathways with significant commonality. The Society of Critical Care Medicine Adult Critical Care Physician Core Knowledge and Skills Task Force aimed to delineate the common core knowledge and skills required of all intensivists.
Design:
A master list of content areas and procedural skills was compiled from all CCM subspecialty program requirements and blueprints of the certification examinations. Using a modified Delphi approach, participants were asked to categorize the knowledge items as “advanced knowledge is essential,” “general, but not advanced, knowledge is essential,” or “knowledge is not essential.” Procedures were categorized as “intensivist performs routinely,” “intensivist only performs in an emergency,” or “intensivist knows” about the procedure.
Setting:
Representatives from CCM stakeholder organizations, including accreditation and certification organizations, critical care societies, and program directors’ societies, were invited to participate.
SUBJECTS:
Members of the Adult Critical Care Physician Core Knowledge and Skills Task Force of the Society of Critical Care Medicine.
Interventions:
For the first two rounds of the modified Delphi process, Research Electronic Data Capture was used. For the third and fourth rounds, the process was completed through online meetings with Zoom (Zoom Video Corporations, San Jose, CA) utilizing Zoom’s polling feature.
Measurements and Main Results:
A total of 541 items were determined to be essential, with 145 requiring advanced knowledge and 323 requiring general knowledge. For 73 items, consensus regarding advanced vs. general could not be achieved, but they remained essential. Only eight items were felt to be nonessential. Of the 16 procedures, most were categorized as “intensivist performs.”
TABLE 2. - Items Considered to Be Nonessential
| Content Heading | Specific Topic |
|---|---|
| Cardiovascular and resuscitation | Congenital heart disease in adults (e.g., tetralogy of Fallot, Eisenmenger syndrome) |
| Gastrointestinal: Diagnostic and therapeutic modalities | Biopsy of liver |
| Pediatrics | Life-threatening congenital conditions |
| Pediatrics | Nonaccidental trauma |
| Neurology: Diagnoses | Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes |
| Neurology: Diagnostic modalities | Microdialysis |
| Procedures | Sleep studies |
| Procedures: Ultrasound | Ocular |
TABLE 3. - Procedures
| Procedure | Performs Routinely | Performs Only in an Emergency | Knows |
|---|---|---|---|
| Vascular access | 98% | 2% | 0% |
| Bronchoscopy | 98% | 2% | 0% |
| Point of care ultrasound | 94% | 4% | 2% |
| Moderate and deep procedural sedation | 94% | 4% | 2% |
| Airway management | 89% | 11% | 0% |
| Electrical cardioversion | 85% | 15% | 0% |
| Thoracentesis | 81% | 13% | 6% |
| Paracentesis | 74% | 17% | 9% |
| Brain death examination | 72% | 4% | 23% |
| Tube thoracostomy/chest tube | 62% | 36% | 2% |
| Lumbar puncture | 53% | 19% | 28% |
| Temporary transvenous pacemaker | 21% | 62% | 17% |
| Cricothyrotomy | 19% | 72% | 9% |
| Pericardiocentesis | 15% | 66% | 19% |
| Tracheostomy | 11% | 23% | 66% |
| Extracorporeal membrane oxygenation cannulation | 9% | 17% | 74% |
Conclusions:
The large number of items included in the list of essential knowledge and skills demonstrates the complexity of modern CCM. Utilization of a common framework across the subspecialties of CCM could lead to greater harmonization among the fellowship program requirements and certification examinations.
