Intensive care in England and Wales. A survey of current practice, training and attitudes.

A questionnaire circulated to members of the Intensive Care Society in England and Wales brought 101 replies, representing 74 hospitals, including 16 teaching hospitals. Anaesthesia is the dominant specialty in this field and the majority of general units included in this survey are staffed and directed by consultants from this specialty, though their involvement in such work varies widely. Only about half the units are largely supervised by consultants with a heavy commitment to it. The junior staff too are predominantly anaesthetists. Whilst the FFARCS examination strongly emphasises the importance of intensive care to the specialty, only about half the members believe present training in this field, including academic activity, is satisfactory. The dearth of full-time training posts, their brevity and their domination by the teaching hospitals are major problems. There is considerable support for the idea of National Training Standards, and for a full-time training period of not less than 2 years, including special experience in certain fields, for those with a special interest in and aptitude for this type of work. But there is much less support for a Diploma. Despite this agreement on special training, only a small minority of members believe intensive care work should largely be restricted to separate career specialists, "intensivists'. However most recognise the need for each unit to have a largely full-time manager and coordinator, whose personal qualities are more important than his original specialty. Most units have one kind of problem or another, the most common being a shortage of money and nurses.