Competency Based Training in Intensive

Care Medicine in Europe

ESICM; University of Birmingham; Charles University; Picker

Institute Europe; Intensium Oy

CoBaTrICE is supported by a grant from the European Union - Leonardo da Vinci Programme.
Additional supporters: GlaxoSmithKline; SSCM; Pfizer (HK); Maquet; ESICM
 Collaboration ESICM CURRICULUM MAP
EU grant Div Prof Dev
52 NCs Phase 4: Educational
41 countries Resources
National orgs Learning & teaching
European
Board ICM Phase 3: Assessment

Survey Descriptors of how

EDIC competencies are
41 PHASE
countries1: assessed in workplace
54
Survey
ICM training
of ICM
programmes
training PHASESyllabus
2iii:
Delphi Syllabus skills &
Knowledge,
iteration development
attitudes for each
Competency competence
Web-based Delphi
statements on Final
Draft competence set
competence set
5,241 suggestions
website
535 contributors
>50 countries
PHASE 2:
Competence
development Nominal Group
Questionnaire 12 members
(patients, relatives)
169 competency statements
70 ICUs
Rating level & importance
8 EU countries
• Curriculum: the entire training programme, including
competencies, syllabus, assessment methods,
educational resources etc.

• Syllabus: all the knowledge, skills and attitudes in the

curriculum – everything you can learn.

• Syllabus elements: A single item of knowledge, or a

skill, or an attitude.
• A competence: a task or activity which can be
described in terms of knowledge, skills and attitudes,
and which can be assessed in the workplace.

• A domain: a collection of competencies

 Stakeholders in ICM...
5 PARTNERS

Patients & Relatives Critical Care

Professionals

10 NATIONAL ICM 42 NATIONAL

REPORTERS STAKEHOLDERS COORDINATORS
(Worldwide) (Europe)

National and International Trainers & Trainees

Organisations
INTERNATIONAL
ADVISORY BOARD
 Consensus development of competencies

Online Delphi (2i): Survey of

Health care professionals and Educators patients and relatives (2ii)

Nominal Group Ranking

2nd round Delphi &

Editorial review

(June – Sept. 2005)

Syllabus development

Editorial review

(Dec. 2005) CORE ICM COMPETENCIES

linked to syllabus
 Online Delphi
Data collection: 4 month period extended to 6
Targeted advertisement & progress reports to NCs

• 536 respondents
• 58 countries
• 8 languages
• 5241 suggestions
• 1 – 134 suggestions per
person (mode = 10)
Specialist, ICM Specialist, other
• Suggestions categorised Trainee ICM Nurse
using 35 pre-determined Medical student Trainee, other
keywords Educator AHP
Frequency of suggestions: top 10 categories

PRACTICAL PROCEDURES

PROFESSIONALISM (attitudes &

behaviours)

DATA INTERPRETATION

PROFESSIONALISM
(communication)

DISEASE

ORGAN FAILURE / SUPPORT -

Respiratory

SCIENCES

MANAGEMENT

MONITORING

THERAPY

0 200 400 600 800 1000 1200

Practical procedures the most frequently cited single category, but

professionalism (attitudes & behaviours, and communication) equally cited
 Competence stems
Online Delphi
5241 competence suggestions Consumer Survey -
patients and relatives
35 Keyword Categories
(multiple categories allowed) 21 items & free text
→ 3 key themes
Key themes summarised
(10 – 20 per category)

Editorial process

35 Keyword categories → 17 Domains

Summaries refined → Competence stems

169 Competence stems

 Constructing a Competence statement
from each stem
Context:
“By the end of ICM specialist training, the trainee…”

Level of expertise: “...describes...”

“...demonstrates...”
“...performs...”
“...manages...”

Competence stem:
“...endotracheal intubation”
 Generic levels of expertise
Teaches or
supervises others in (Leads...;
the performance, Supervises...;
management or Teaches...)
demonstration of...
Performs, manages or
demonstrates...
Independently

(Demonstrates...; Performs...;
Performs, manages or Manages....; Conducts...)
demonstrates ...under
supervision

Has knowledge of...

(Knows...; Identifies...; Understands...; Describes...)
 Nominal Group Tasks
For each competence stem the NG:
1. Agreed the minimum level of expertise:
By the end of ICM specialist training, the trainee...
Has knowledge of, Performs, manages or Performs, manages Supervises or teaches
describes… demonstrates under or demonstrates others in the performance,
supervision… independently… management or
demonstration of…

Then:
2. Rated the importance of the competence statement:
1 2 3 4 5
Unimportant, of Minor Moderate Important Very important,
little relevance importance importance essential
 NG Output
Minimum level of expertise:
• There was no complete consensus before discussion
• Consensus was achieved for all competencies after discussion
• Discussion revealed…
 the need to compromise between desirable versus deliverable
training opportunities
 diversity in national ICM practice & professional roles

NG Rating of importance:
• 111 = high importance (mean >4)
• 50 = moderate importance (mean 3 - 4)
• 8 = low importance (mean <3)
 Core competencies: key considerations

Context:
• ICM programmes vary in structure, duration & format
• Trainees from different base specialities
• Differences in ICM practices and roles of specialists

Core competencies must be:

• Relevant - must be applicable to all training programmes
• Realistic - must be achievable in the ICUs in which trainees
undertake training
• Flexible - must be able to accommodate differences in ICM
practices and professional roles
 Outcome: Level of expertise
• Minimum level of expertise = baseline level
This does not restrict scope for acquiring competencies at an enhanced
level of expertise (local / national guidelines)

• Expertise simplified to 3 levels:

Knowledge By the end of specialist training, the trainee describes...

By the end of specialist training, the trainee....

Supervised practice
(performs / manages / demonstrates etc.) ...under supervision
By the end of specialist training, the trainee....
Independent practice
(performs / manages / demonstrates etc.)

• Supervision included as a competence statement:

“By the end of specialist training, the trainee appropriately supervises, or
delegates to others, the delivery of patient care”
 Outcome: Competence statements
• Common themes merged: reduce repetition, remove discrepancies &
allow for differences in local practices
• Simple airway adjuncts
• Bag and mask ventilation By the end of specialist
• Laryngeal mask airway
• Orotracheal (or nasotracheal) intubation
training, the trainee performs
• Rapid sequence induction of anaesthesia to emergency airway
secure the airway management
(All at level of independent practice)

• Themes from all statements rated high or moderately important included:

as statements or as syllabus elements

• Themes from statements rated unimportant but commented upon in R2 Delphi

available as syllabus elements (e.g. supra-pubic catheterisation)

• 108 competence statements grouped into 13 domains

 Building the syllabus

• Database of syllabus elements (>2000) - content analysis of

international guidelines and ICM national curricula (UK, Belgium, Spain,
Canada, USA, Australia) & Delphi material
• Each competence statement linked to elements of knowledge,
skills and attitudes

EDITORIAL REVIEW IN PROGRESS:

•Syllabus compiled for each domain:
- identify any missing items
- identify any missing links for individual competencies or
discrepancies between competencies & selections made

• Competence statements and domains reviewed  101 competence

statements grouped in 12 domains
 12 Domains

A Resuscitation & initial management of the acutely ill patient

B Assessment, investigation, monitoring and data interpretation
C Diagnosis and disease management
D Therapeutic interventions / organ system support
E Practical procedures
F Peri-operative care
GH Continuity, comfort and recovery
I End of life care
J Paediatric care
K Transport
L Patient safety & systems management
M Professionalism
Example of a Domain...
Example of syllabus elements...
 The next 12 months....
• Developing assessment benchmarks
PHASE 3 • Identifying assessment methods &
guidelines for their use
Assessment WG

• Identifying existing educational resources

PHASE 4 to support acquisition of competencies
Educational Resources WG

Development of electronic framework to link:

competencies, syllabus, assessment guidelines &
educational resources...
 Acknowledgements
CoBaTrICE Steering Committee Partners:
G. Libreau; A. Augier (European Society of Intensive Care Medicine); J.Bion; H.Barrett, 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).
CoBaTrICE National Coordinators, Reporters and Deputies:
A.Gallesio (Argentina); C.Krenn (Austria); J.H.Havill (Australia & New Zealand); P.Ferdinande (Belgium); D. De Backer (Belgium); E.Knobel
(Brazil); I.Smilov (Bulgaria); Y Petkov (Bulgaria); D Leasa (Canada); R.Hodder (Canada); V.Gasparovic (Croatia); R.Radonic (Croatia);
T.Kyprianou (Cyprus); M.Kakas (Cyprus); V.Sramek (Czech Republic); V.Cerny (Czech Republic); O Palmer (Costa Rica); Y.Khater (Egypt);
S.Sarapuu (Estonia); J.Starkopf (Estonia); T.Silfvast (Finland); P.Loisa (Finland); J.Chiche (France); B.Vallet (France); M.Quintel (Germany);
A.Armaganidis (Greece); A.Mavrommatis (Greece); C.Gomersall (Hong Kong); G.Joynt (Hong Kong); T.Gondos (Hungary); A.Bede (Hungary);
S.Iyer (India); I.Mustafa (Indonesia); B.Marsh (Ireland); D.Phelan (Ireland); P.Singer (Israel); J.Cohen (Israel); A.Gullo (Italy); G.Iapichino (Italy);
Y.Yapobi (Ivory Coast); S.Kazune (Latvia); A.Baublys (Lithuania); T.Li Ling (Malaysia); A.Van Zanten (Netherlands); A.Girbes (Netherlands);
A.Mikstacki (Poland); B.Tamowicz (Poland); J.Pimentel (Portugal); P.Martins (Portugal); J.Wernerman (Scandinavia); E.Ronholm (Scandinavia);
R.Zahorec (Slovakia); J.Firment (Slovakia); G.Voga (Slovenia); R.Pareznik (Slovenia); G.Gonzalez-Diaz (Spain); L.Blanch (Spain); P.Monedero
(Spain); H.U.Rothen (Switzerland); M.Maggiorini (Switzerland); N.Ünal (Turkey); Z.Alanoglu (Turkey); A.Batchelor (UK); K.Gunning (UK);
T.Buchman (USA).
CoBaTrICE Advisory Board:
Dr T.Buchman (SCCM); Dr S.Rounds (ATS); Dr H Van Aken (UEMS); Dr A.Rossi (ERS); Dr M.Elliott (ERS); Dr J.Besso (Panamerican and Iberic
Federation of Societies of Intensive Care Medicine); Dr J.Ramet (ESPNIC); Dr HJ.Priebe (ESA); Dr G.Park (World Federation of Societies of
Intensive and Critical Care Medicine); Dr D.Zideman (ERC); Dr TS.Koon (WPACCM); Dr N.T. Mathews ((ANZICS); Dr D.Dreyfuss (CNERM); Dr
W.Hacke (DIVI); Dr L.Cabré (SEMICYUC); Dr F.Esen (Turkish National Society of Intensive Care Medicine); Dr JE. Morris (Critical Care
Information Advisory Group, UK); Asst. Prof. J. Williams (WfCCN).
CoBaTrICE Nominal Group:
Dr A van Zanten (Netherlands); Dr S Iyer (India); Dr U Bartels (Germany); Dr A Armaganidis (Greece); Dr C Gomersall (Hong Kong); Dr A
Larsson (Denmark); Dr F Rubulotta (Italy); Dr P Ferdinande (Belgium); Prof J Scholes (UK); Dr M Parker (USA); Dr J.A.Romand (Switzerland);
Dr V Gasparovic (Croatia).
CoBaTrICE Delphi participants
CoBaTrICE ICU Representatives
Sincere thanks to the 10 representatives in each country: Italy; Spain; Denmark; UK; Switzerland; Netherlands; Czech R, Poland.
CoBaTrICE Grant:
European Union – Leonardo da Vinci Programme; Additional supporter: GlaxoSmithKline.