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Development of core competencies for an international training programme in intensive care medicine

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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.

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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).

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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

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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]).

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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

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