Pittsburgh's program, one of the first and, with about 40 fellows, one of the largest in the country, now runs simulations in a multilevel facility using actors and "robotic" humans. There, future intensivists practice crisis management and learn how to lead an entire ICU team. In one scenario, an actor playing a patient diagnosed with an aggressive cancer becomes unstable, with multiple organ failure. And just as NFL teams review tape to improve performance, "we use video to evaluate how the fellows perform in an end-of-life situation," says Angus.
The football analogy doesn't stop there. Being an intensivist means keeping a lot of people in the loop, says Frankel. "Some liken it to being the captain of a ship, but I think it's more like being a quarterback."