Abstract
Objective
The aim of this study was to define the core (minimum) competencies required of a specialist in adult intensive care medicine (ICM). This is the second phase of a 3-year project to develop an internationally acceptable competency-based training programme in ICM for Europe (CoBaTrICE).
Methodology
Consensus techniques (modified Delphi and nominal group) were used to enable interested stakeholders (health care professionals, educators, patients and their relatives) to identify and prioritise core competencies. Online and postal surveys were used to generate ideas. A nominal group of 12 clinicians met in plenary session to rate the importance of the competence statements constructed from these suggestions. All materials were presented online for a second round Delphi prior to iterative editorial review.
Results
The initial surveys generated over 5,250 suggestions for competencies from 57 countries. Preliminary editing permitted us to encapsulate these suggestions within 164 competence stems and 5 behavioural themes. For each of these items the nominal group selected the minimum level of expertise required of a safe practitioner at the end of their specialist training, before rating them for importance. Individuals and groups from 29 countries commented on the nominal group output; this informed the editorial review. These combined processes resulted in 102 competence statements, divided into 12 domains.
Conclusion
Using consensus techniques we have generated core competencies which are internationally applicable but still able to accommodate local requirements. This provides the foundation upon which an international competency based training programme for intensive care medicine can be built.
Similar content being viewed by others
References
Barrett H, Bion JF on behalf of the CoBaTrICE collaboration (2005) An international survey of training in adult intensive care medicine. Intensive Care Med 31:553–561
Anonymous (1993) Council Directive 93/16/EEC of 5 April 1993 to facilitate the free movement of doctors and the mutual recognition of their diplomas, certificates and other evidence of formal qualifications. nominal group (NG http://www.ilo.org/public/english/employment/skills/recomm/instr/eu_5.htm (accessed 18 January 2006)
Anonymous (2002) Proposal for a directive of the European Parliament and of the Council of 7 March 2002 on the recognition of professional qualifications. COM 119 final, Official J C181E of 30 July 07 http://europa.eu.int/scadplus/leg/en/cha/c11065.htm (accessed 18 January 2006)
Barrett H, Bion J, Field S, Bullock A, Hasman A, Askham J, Kari A, Mussalo P on behalf of the CoBaTrICE collaboration (2005) Abstract 85N—consensus methodology: developing a competency based training programme in intensive care medicine. AMEE. http://www.amee.org/conf2005/2005_abstracts.pdf (accessed 18 January 2006)
Barrett H, Bion JF on behalf of the CoBaTrICE Collaboration (2005) CoBaTrICE: development of core competencies. Intensive Care Med 31 [Suppl 1]:S220
Barrett H, Bion JF on behalf of the CoBaTrICE Collaboration (2005) CoBaTrICE Core competencies and syllabus development. Crit Care Med 33 [Suppl]:A14
Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CFB, Askham J, Marteau T (1998) Consensus development methods, and their use in clinical guideline development. Health Technol Assess 2
Perkins GD, Barrett H, Bullock I, Gabbott DA, Nolan JP, Mitchell S, Short A, Smith CM, Smith GB, Todd S, Bion JF (2005) The Acute Care Undergraduate Teaching (ACUTE) initiative: consensus development of core competencies in acute care for undergraduates in the UK. Intensive Care Med 31:1627–1633
Stewart J, O'Halloran C, Harrigan P, Spencer JA, Barton R, Singleton SJ (1999) Identifying appropriate tasks for the pre-registration year: modified Delphi technique. BMJ 319:224–229
McKee M, Priest P, Ginzler M, Black N (1992) Which tasks performed by preregistration house officers out of hours are appropriate? Med Educ 26:51–57
McLeod P, Steinert Y, Meterissan S, Child S (2004) Using the Delphi process to identify the curriculum. Med Educ 38:548
Alahlafi A, Burge S (2005) What should undergraduate medical students know about psoriasis? Involving patients in curriculum development: modified Delphi technique. BMJ 330:633–636
Williams PL, Webb C (1994) The Delphi technique: a methodological discussion. J Adv Nurs 19:180–186
Boath E, Mucklow J, Black P (1997) Consulting the oracle: a Delphi study to determine the content of a post graduate distance learning course in therapeutics. Br J Clin Pharmacol 43:643–647
Walley T, Webb DJ (1997) Developing a core curriculum in clinical pharmacology & therapeutics: a Delphi study. Br J Clin Pharmacol 44:167–170
MacDonald EB, Ritchie KA, Murray KJ, Gilmour WH (2000) Requirements for occupational medicine training in Europe: a Delphi study. Occup Environ Med 57:98–105
Lane DS, Ross V (1994) The importance of defining physicians' competencies: lessons from preventative medicine. Acad Med 69:972–974
Jones J & Hunter D (1995) Qualitative Research: Consensus methods for health services research. BMJ 311:376–380
Vella K, Goldfrad C, Rowan K, Bion J, Black N (2000) Use of consensus development to establish national research priorities in critical care. BMJ 320:976–980
Goldfrad C. Vella K. Bion JF. Rowan KM. Black NA (2000) Research priorities in critical care medicine in the UK. Intensive Care Med 26:1480–1488
Hasman A, Askham J on behalf of the CoBaTrICE collaboration (2005) Abstract 073-CoBaTrICE Survey of patients and relatives in intensive care medicine. Intensive Care Med 31 [Suppl 1]:S23
Thijs LG, Baltopoulos G, Bihari D, Burchardi H, Carlet J, Chioléro R, Dragsted L, Edwards DJ, Ferdinande P, Giunta F, Kari A, Kox W, Planas M, Vincent JL, Pfenninger J, Edberg KE, Floret D, Leijala M, Tegtmeyer FK (ESICM & ESPNIC task force) (1996) Guidelines for a training programme in intensive care medicine. Intensive Care Med 22:166–172
Vincent JL, Baltopoulos G, Bihari D, Blanch L, Burchardi H, Carrington da Costa RB, Edwards D, Iapichino G, Lamy M, Murrillo F, Raphael JC, Suter P, Takala J, Thijs LG (ESICM task force) (1994) Guidelines for training in intensive care medicine. Intensive Care Med 20:80–81
De Lange S, Van Aken H, Burchardi H (2002) European society of Intensive Care Medicine: Intensive care medicine in Europe-structure, organisation and training guidelines of the Multidisciplinary Joint Committee of Intensive Care Medicine (MJCICM) of the European Union of Medical Specialists (UEMS). Intensive Care Med 28:1505–1511
Dorman T, Angood PB, Angus DC, Clemmer TP, Cohen NH, Durbin CG, Falk JL, Helfaer MA, Haupt MT, Horst HM, Ivy ME, Ognibene FP, Sladen RN, Grenvik ANA, Napolitano LM (2004) Guidelines for critical care medicine training and continuing medical education. Crit Care Med 32:263–272
Anonymous (1997) Guidelines for advanced training for physicians in critical care. American College of Critical Care Medicine of the Society of Critical Care Medicine. Crit Care Med 25:1601–1607
Royal College of Physicians and Surgeons of Canada (2002) Specific standards for accreditation and specialist training requirements for residency programs in adult critical care medicine. http://rcpsc.medical.org/residency/accreditation/ssas/critcare-adult_e.html (accessed June 2004)
IBTICM (2001) The CCST. In: Intensive care medicine competency based training and assessment. I. A reference manual for trainees and trainers. http://www.rcoa.ac.uk/ibticm/docs/CBTPart1.pdf (accessed June 2004)
ANZICS (2003) Objectives of training in intensive care for the diploma of fellowship of the joint faculty of intensive care medicine, Australian and New Zealand College of Anaesthetists and Royal Australian College of Physicians, 2nd edn
Roca Guiseris et al (2006) SEMICYUY Skill map: ICM specialist's competence. Med Intensiva. (in press)
Anonymous (2004) Curriculum for the Diploma of the Irish board of intensive care medicine (DIBICM). http://www.icmed.com/i_b_i_c_m.htm (accessed June 2004)
Karimi A, Dick W (1997) German Interdisciplinary Association of Critical Care Medicine (DIVI) Excerpt from recommendations on problems in emergency and intensive Care Medicine. DIVI
Webb AR, Shapiro MJ, Singer M, Suter PM (eds) (1999) Oxford textbook of critical care. Oxford University Press, Oxford
Bersten AD, Soni N (eds) (2003) Oh's intensive care manual. Butterworth-Heinemann, Edinburgh
Hall JB, Schmidt GA, Wood LDH (1992) Principles of critical care. McGraw-Hill, New York
Royal College of Physicians (2005) Doctors in society: medical professionalism in a changing world. Report of a working party of the Royal College of Physicians of London. RCP, London. http://www.rcplondon.ac.uk/pubs/books/docinsoc/docinsoc.pdf (accessed 18 January 2006)
Royal College of Anaesthetists (2003) The CCST in anaesthesia. I, General principles, sect 5.2, edn, 2 April
Alspach JG (1984) Designing a competency-based orientation for critical care nurses. Heart Lung 13:655–662
McMullan M, Endacott R, Gray M et al (2003) Portfolios and assessment of competence. J Adv Nurs 41:283–294
Acknowledgements
Principle Authors: Dr. J.F. Bion (CoBaTrICE Project lead), H. Barrett (CoBaTrICE Research nurse) on behalf of the CoBaTrICE Collaboration: Steering Committee Partners: A. Augier, D d'Hoir (European Society of Intensive Care Medicine); J. Lonbay, S. Field, A. Bullock,(University of Birmingham); I. Novak (Charles University); J. Askham, A. Hasman (Picker Institute Europe); A. Kari, P. Mussalo, J. Väisänen (Intensium Oy). National Coordinators, National Reporters and Deputies: A. Gallesio, S. Giannasi (Argentina); C. Krenn (Austria); J.H. Havill (Australia, New Zealand); P. Ferdinande, D. De Backer (Belgium); E. Knobel (Brazil); I. Smilov, Y. Petkov (Bulgaria); D. Leasa, R. Hodder (Canada); V. Gasparovic (Croatia); O. Palma (Costa Rica); T. Kyprianou, M. Kakas (Cyprus); V. Sramek, V. Cerny (Czech Republic); Y. Khater (Egypt); S. Sarapuu, J. Starkopf (Estonia); T. Silfvast, P. Loisa (Finland); J. Chiche, B. Vallet (France); M. Quintel (Germany); A. Armaganidis, A. Mavrommatis (Greece); C. Gomersall, G. Joynt (Hong Kong); T. Gondos (Hungary); A. Bede (Hungary); S. Iyer (India); I. Mustafa (Indonesia); B. Marsh, D. Phelan (Ireland); P. Singer, J. Cohen (Israel); A. Gullo, G. Iapichino (Italy); Y. Yapobi (Ivory Coast); S. Kazune (Latvia); A. Baublys (Lithuania); T. Li Ling (Malaysia); A. Van Zanten A. Girbes (The Netherlands); A. Mikstacki (Poland); B. Tamowicz (Poland); J. Pimentel, P. Martins (Portugal); J. Wernerman, E. Ronholm, H. Flatten (Scandinavia); R. Zahorec, J. Firment (Slovakia); G. Voga, R. Pareznik (Slovenia); G. Gonzalez-Diaz, l. Blanch, P. Monedero (Spain); H.U. Rothen, M. Maggiorini (Switzerland); N. Ünal, Z. Alanoglu (Turkey); A. Batchelor, K. Gunning (United Kingdom); T. Buchman (United States). CoBaTrICE Nominal Group: Dr. A. Armaganidis (Greece); Dr. U. Bartels (Germany); Dr. P. Ferdinande (Belgium); Dr. V. Gasparovic (Croatia); Dr. C. Gomersall (Hong Kong); Dr. S. Iyer (India); Dr. A. Larsson (Denmark); Dr. M. Parker (United States); Dr. J.A. Romand (Switzerland); Dr. F. Rubulotta (Italy); Prof. J. Scholes (United Kingdom); Dr. A van Zanten (The Netherlands). The CoBaTrICE Editorial Working Group: J. Bion (Chair); l. Blanch (Spain); C. Gillbe (United Kingdom); T. Gondos (Hungary); D. Grimaldi (France); T. Kyprianou (Cyprus); D. McAuley (United Kingdom); A. Mikstacki (Poland); I. Novak (Czech Republic); D. Phelan (Ireland); G. Ramsay (The Netherlands); E. Ronholm (Denmark); H.U. Rothen (Switzerland). CoBaTrICE is supported by a grant from the European Union, Leonardo da Vinci programme. Additional support is provided by ESICM, SCCM, GlaxoSmithKline and Pfizer (Hong Kong). This research project is supported by the European Critical Care Research Network (ECCRN) of the European Society of Intensive Care Medicine (ESICM).
Author information
Authors and Affiliations
Consortia
Additional information
On behalf of The CoBaTrICE Collaboration:
H. Barrett · J.F. Bion ✉ Queen Elizabeth Hospital, University Department of Anaesthesia and Intensive Care, Edgbaston, B5 2TT Birmingham, UK email: UniSecICM@uhb.nhs.uk email: h.barrett@bham.ac.uk Tel.: +44-121-6272060 Fax: +44-121-6272062
Electronic supplementary material
Appendix: Glossary
Appendix: Glossary
Competence
The ability to integrate generic professional attributes with specialist knowledge, skills and attitudes and apply them in the workplace.
Competence stem
The topic or activity which can be combined with a descriptor of context and level of expertise to form a competence statement.
Competence statement
A task or activity which can be described in terms of knowledge, skills and attitudes, and which can be assessed in the workplace (pl = competencies).
Competency-based training
A strategy which aims to standardise the outcome of training (what sort of specialist will be produced) rather than the educational processes (how the specialist is produced).
Competency-based training programme
A programme which defines the outcomes (competencies) required of physicians at different stages of training, provides guidelines for the assessment of these outcomes and educational resources to support their acquisition within the workplace. Outcomes, articulated as competency statements, are defined in a manner which facilitates integration of knowledge, skills and attitudes and assessment of performance to a common standard during routine clinical work.
Curriculum
The entire training programme.
Descriptors of level of expertise
Descriptive terms used to indicate the depth of experience required (for example: ‘knows’, ‘demonstrates’, ‘performs’, ‘manages’) and the criteria by which the specialist will be judged on a particular topic (for example, ‘describes’ would require knowledge to be recited; ‘performs’ would require demonstration of a task being undertaken).
Direct Supervision
The supervisor is working directly with the trainee, or can be present within seconds of being called [37].
Domain
A collection of competence statements grouped by a common theme.
Indirect supervision
The supervisor is not working directly with the trainee. The supervisor may be: (a) local, on the same geographical site, is immediately available for advice, and is able to be with the trainee within 10 min of being called, or (b) remote, rapidly available for advice but is off the hospital site and/or separated from the trainee by more than 10 min. [37]
Level of expertise
The depth of experience required by the specialist in order to be considered competent. Three generic levels have been used: knowledge, supervised practice, independent practice. These levels are intended to guide action rather than dictate it for all circumstances. For example, independent practice thus does not require the specialist to perform all aspects of care alone; this level of practice may vary from recognising a clinical situation in which assistance is required (independently) and seeking help (independently), through to managing the situation independently. It is the decision making and associated action which is known about, performed under supervision or performed independently.
Supervisor
The person with the most appropriate skills for that task and environment in which supervision is occurring; it does not imply ownership by a particular specialty. In general terms supervision of an ICM trainee will be provided by a specialist in ICM with due attention to multidisciplinary practice.
Syllabus
All the knowledge, skills and attitudes in the curriculum; everything a trainee can learn (derived from [1, 37, 38, 39]).
Rights and permissions
About this article
Cite this article
The CoBaTrICE Collaboration. Development of core competencies for an international training programme in intensive care medicine. Intensive Care Med 32, 1371–1383 (2006). https://doi.org/10.1007/s00134-006-0215-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-006-0215-5