Taking charge. Although the ICU is hardly the boardroom, critical care training programs focus increasingly on developing managerial skills. "Intensivists need to be leaders during medical crises, managing a whole cadre of nurses, pharmacists, and respiratory therapists," says Angus. Beyond the medical staff, the intensivist must coordinate with social workers and case managers to help patients' families. "When patients are that sick, it's not only a crisis of the body but a crisis of the family. And intensivists are able to develop deep bonds with them in a relatively short period of time," notes Stephen Frankel, section head of critical care and hospital medicine at National Jewish Medical and Research Center in Denver.
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."