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Objective: To describe current arrangements for postgraduate training and speciality status for intensive care medicine in Europe, and to compare these with three other geographical regions: the Middle East, North America, and Australia and New Zealand., Methods: An iterative survey, by questionnaire and direct discussion, of council members of the European Society of Intensive Care Medicine, national specialist societies with involvement in intensive care, and national experts, representing four geographical regions and 47 countries., Results: For the purposes of analysis, countries with common training structures have been grouped together; the denominator therefore includes both countries and regions. Formal training programmes in intensive care medicine (ICM) are available in 18 (85%) of the 21 countries or regions surveyed. Twelve (57%) offer multidisciplinary access to intensive care training with a common core curriculum. In six (28%) training in ICM is available solely through anaesthesia. The duration of intensive care training required for recognition as a specialist in the 18 countries or regions with a formal programme ranges from 18 to 30 months, with a median of 24 months. All countries assess competence in intensive care, but methods for doing so vary widely. Eighteen countries or regions offer specialist registration (accreditation) in ICM; in 12 this is provided as dual accreditation in a base speciality and in ICM., Conclusions: There is substantial support for multidisciplinary training in ICM, as demonstrated by collaborative interspeciality developments in many countries. We propose that these national developments should be strengthened within Europe by the recognition of 'supra-speciality' status for ICM by the European Commission, and by the establishment of a multidisciplinary Board for training in ICM, with international agreement on core competencies and duration of training programmes, and a common approach to the assessment of competence through formal examination.