Introduction and Context
In December 2025, the Society of Critical Care Medicine (SCCM) published the results of an ambitious, multidisciplinary effort to define the core knowledge and procedural skills that all physicians who manage critically ill adults (intensivists) should possess (Tisherman et al., Crit Care Med. 2025). The Adult Critical Care Physician Core Knowledge and Skills Task Force assembled content from subspecialty certification blueprints and program requirements, then used a modified Delphi process to reach consensus across stakeholder organizations.
Why this effort matters now: intensive care practice has grown more complex and subspecialized over the last two decades. Training pathways evolved in parallel across internal medicine, anesthesiology, surgery, emergency medicine and other disciplines, creating largely overlapping but not identical fellowship requirements and certification blueprints. The SCCM task force sought to identify what is common and essential across these pathways, with the goal of promoting consistency in training, assessment, and ultimately patient care.
New Guideline Highlights
Major outcomes and takeaways:
– A total of 541 items were designated as essential knowledge or skills for adult intensivists.
– 145 items were judged to require “advanced knowledge is essential.”
– 323 items were judged to require “general, but not advanced, knowledge is essential.”
– 73 items were retained as essential even though panelists could not reach consensus on “advanced” vs “general.”
– Only 8 items were felt to be nonessential.
– Procedure categorization: of 16 procedures evaluated, most were placed in the category “intensivist performs,” with a minority designated as “performs only in an emergency” or “intensivist knows about the procedure.”
– Process: Modified Delphi across four rounds, incorporating online surveys (REDCap) and two live Zoom consensus meetings with polling.
Key message: modern critical care requires a large, clearly defined core. This list can underpin harmonized fellowship requirements, exam blueprints, and competency-based curricula across subspecialties.
Updated Recommendations and Key Changes
This project is not a traditional therapeutic guideline but a consensus-derived framework. Important shifts relative to previous, siloed training documents include:
– Harmonization over fragmentation: rather than separate lists tethered to each primary specialty, the consensus provides a single cross-disciplinary core that highlights common expectations for intensivists regardless of their parent specialty.
– Granularity: items are triaged by level of mastery (advanced vs general), which is more actionable than previous binary “required/not-required” lists.
– Procedural clarity: procedures were explicitly classified into “routine performer,” “emergency-only performer,” or “knows about,” helping programs decide what procedures should be included in hands-on training versus cognitive instruction.
Evidence driving the updates: the list was built from existing fellowship program requirements and certification exam blueprints (themselves based on decades of specialty-specific expert consensus) and then refined by broad stakeholder input. The modified Delphi method is a well-established approach to delineating consensus in complex fields (Hsu & Sandford, 2007).
Topic-by-Topic Recommendations
The consensus itemizes content domains; the Task Force did not provide graded therapeutic recommendations in the GRADE sense but instead categorized knowledge/skills into essential tiers. Below are distilled topic-level summaries and examples.
1) Clinical domains and diagnostic skills
– Hemodynamic monitoring and shock: Advanced knowledge essential
– Interpreting arterial pressure waveforms, pulmonary artery catheter data, cardiac output modalities, and dynamic tests of fluid responsiveness.
– Respiratory failure and mechanical ventilation: Advanced knowledge essential
– Mode selection, ventilator waveforms, lung-protective strategies for ARDS, and weaning protocols.
– Sepsis and infection management: General knowledge essential
– Recognition, initial resuscitation, source control principles, and antimicrobial stewardship; advanced familiarity for complex immunocompromised patients.
– Neurologic critical care: General knowledge essential; advanced knowledge marked for neurocritical care scenarios (intracranial pressure monitoring, targeted temperature management).
2) Procedural skills (16 procedures evaluated)
– Most procedures categorized as “intensivist performs”
– Examples: endotracheal intubation, central venous catheter insertion, arterial line placement, percutaneous tracheostomy (in many programs), bedside chest tube insertion.
– Emergency-only performers
– Examples where the panel recommended intensivists perform only in emergent situations included certain advanced airway rescue techniques or high-risk hemorrhage control procedures.
– Knowledge-only
– Procedures frequently performed by other teams (e.g., interventional radiology angiographic embolization) were classed as procedures intensivists should understand but not routinely perform.
3) Systems, teamwork, and nontechnical skills
– Quality improvement, patient safety, handoffs, and leadership: General knowledge essential
– End-of-life care, communication and ethics: General knowledge essential; advanced practice for those leading family meetings in complex cases.
4) Special populations
– Cardiac surgery, trauma, burn, and neurocritical care: Several domain-specific advanced knowledge items were retained to reflect cross-coverage expectations; however, truly subspecialty-level skills were delineated as advanced and often flagged as curricula to be tailored within fellowships.
Recommendation Grades and How to Use the List
The Task Force used categorical consensus rather than numeric GRADE levels. To translate into actionable programmatic change, training programs might map these categories to competency milestones or entrustable professional activities (EPAs):
– “Advanced knowledge is essential” → competency target for completing fellows who will practice independently in general ICUs and specialized units.
– “General knowledge is essential” → baseline competency for all fellows and practicing intensivists; adequate for safe triage and management with specialist consultation.
– “Knowledge is not essential” → optional content, local curricula may choose to include based on patient population.
A sample mapping table (illustrative):
– Advanced (145 items): mastery expected for independent practice; demonstration via simulation, supervised clinical encounters, or formal assessment.
– General (323 items): clinical familiarity and ability to initiate management, with escalation as needed.
– Unsure advanced/general (73 items): recommend individualized curricular approaches and targeted assessment.
Expert Commentary and Insights
Committee viewpoints, emergent controversies, and practical judgments emerged during the process:
– Broad agreement that a common core would reduce variability in fellowship training and improve portability of qualifications across practice settings.
– Debate around procedures: where to draw the line between what an intensivist should “do” versus “know about” reflected local practice patterns. For example, percutaneous tracheostomy was deemed performed by many intensivists but not uniformly — reflecting institutional privileging.
– Workforce implications: by clarifying expectations, the list helps hospitals and credentialing committees decide procedural privileges and resource allocation (e.g., simulation training investments).
– Assessment challenges: experts highlighted the need to couple this content framework with validated assessment tools (milestones, workplace-based assessments, simulation scores) rather than relying solely on procedural counts.
Representative paraphrased expert sentiments from Task Force members:
– “This is not a shrinking of expectations; it’s an honest alignment and prioritization of what intensivists must know to deliver safe care across settings.”
– “Greater clarity will help smaller programs focus faculty teaching time and guide certification bodies in constructing fair, consistent exams.”
Practical Implications for Training Programs, Clinicians, and Credentialers
For fellowship directors
– Map the Task Force list onto your curriculum and identify gaps in teaching resources (simulation, supervised procedures, rotations).
– Use the advanced/general designations to prioritize hands-on training and assessment.
For hospitals and credentialing committees
– The list provides evidence-based justification for privileging decisions and for the scope of practice expected of intensivists.
For certification bodies and exam writers
– Consider aligning blueprints and exam weightings to the consensus core to reduce training–testing mismatch.
For practicing intensivists
– Use the list for self-directed learning and to plan continuing professional development targeting advanced domains.
Case Vignette
John is a 54-year-old man admitted to a tertiary-care medical ICU with severe community-acquired pneumonia complicated by refractory hypoxemia. The admitting intensivist, trained via internal medicine–based CCM fellowship, uses the Task Force framework to guide immediate management: lung-protective ventilation (advanced knowledge), dynamic assessment of fluid responsiveness (advanced), initiation of empiric antibiotics with stewardship considerations (general), and early communication with family regarding prognosis and goals (general). When oxygenation worsens, the intensivist performs prone positioning (an advanced, but essential, bedside therapy) and arranges ECMO consultation—an example of how the core list clarifies what should be done at the bedside and what requires referral.
Limitations and Future Directions
– Consensus-based, not outcome-tested: the list reflects expert opinion and harmonization of existing requirements; prospective validation linking these core items to improved patient outcomes is needed.
– Local practice variability: institutions will need to adapt the list according to available services, patient populations, and credentialing frameworks.
– Assessment tools: the field needs standardized, validated assessments (simulation-based, workplace-based assessment frameworks) mapped to the core list.
The Task Force recommends that this core be used as a living document, periodically updated as critical care practice evolves (new technologies, changing procedural paradigms, and emerging evidence).
References
– Tisherman SA, Spevetz A, Farmer JC, Kashyap R, Michener E, Leichtle SW, et al.; Adult Critical Care Physician Core Knowledge and Skills Task Force of the Society of Critical Care Medicine. Determination of Adult Critical Care Physician Core Knowledge and Skills: Results of a Multidisciplinary, Modified Delphi Process. Crit Care Med. 2025 Dec 9. doi:10.1097/CCM.0000000000006978. Epub ahead of print. PMID: 41363909.
– Accreditation Council for Graduate Medical Education (ACGME). Program Requirements for Graduate Medical Education in Critical Care Medicine. ACGME.org. Accessed 2025.
– American Board of Internal Medicine. Critical Care Medicine Certification Examination Content. ABIM.org. Accessed 2025.
– Hsu C-C, Sandford BA. The Delphi Technique: Making Sense of Consensus. Practical Assessment, Research & Evaluation. 2007;12(10):1–8.
– Society of Critical Care Medicine. Fundamental Critical Care Support (FCCS) Course and Core Curriculum resources. SCCM.org. Accessed 2025.
Bottom line
The SCCM Task Force’s consensus provides a practical, consensus-driven roadmap of 541 core knowledge and procedural items for adult intensivists, categorized by the level of mastery expected. By offering a harmonized cross-specialty framework, the document lays the groundwork for clearer fellowship curricula, fairer certification blueprints, and more consistent credentialing—ultimately aiming to improve the safety and quality of care for critically ill adults.
