For new #ICU fellows the learning curve is STEEP. On reflection, the best fellows seem to master core groups of skills in a somewhat predictable order. Here is my take on the "Maslow's Hierarchy of Needs" equivalent for ICU skills. 1st: Resuscitative Skills --> without competence in resuscitative skills, general ICU care suffers. For example, if you aren't confident in your intubation skills, you won't make the best decisions about EXtubation. 2nd: Core ICU Management Skills --> Some doctors can be excellent at resuscitation, yet lack in the ability to provide excellent ongoing ICU care. The truth that some trainees realize too late imho is that resuscitation is only part of critical care --> the bread and butter is managing complex medical patients on ventilators. 3rd: Family Communication Skills --> Once excellent patient care in the ICU is being mastered (or in parallel with this), excellent fellows master communication with families. A different yet crucial skill set. 4th: Team Management Skills --> Part of being an excellent intensivist is coordinating a multi-disciplinary team. This takes time and practice, and involves the team trusting you to make solid clinical decisions. Last: Resource management --> The final piece to master for many trainees is resource management. This can be at a unit, hospital, or regional level. Of course, no one ever truly masters any of these and we always have so much to learn, but just a pattern i've observed in our best ICU fellows.