Competency Based Training in Intensive Care Medicine in Europe

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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
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CURRICULUM MAP
Collaboration EU grant 52 NCs 41
countries National orgs
ESICM Div Prof Dev
Phase 4 Educational Resources Learning teaching
Phase 4 Educational Resources Learning teaching
European Board ICM
Phase 3 Assessment Descriptors of how
competencies are assessed in workplace
Phase 3 Assessment Descriptors of how
competencies are assessed in workplace
Survey 41 countries 54 ICM training programmes
PHASE 1 Survey of ICM training
EDIC
PHASE 2iii Syllabus development
Syllabus Knowledge, skills attitudes for each
competence
Delphi iteration Competency statements on website
Web-based Delphi 5,241 suggestions 535
contributors gt50 countries
Final competence set
Draft competence set
PHASE 2 Competence development
Nominal Group 12 members 169 competency
statements Rating level importance
Questionnaire (patients, relatives) 70 ICUs 8 EU
countries
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• 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

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Stakeholders in ICM...
Patients Relatives
Critical Care Professionals
Trainers Trainees
National and International Organisations
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(June Sept. 2005) (Dec. 2005)
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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)
• Suggestions categorised using 35 pre-determined
  keywords

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Frequency of suggestions top 10 categories
Practical procedures the most frequently cited
single category, but professionalism (attitudes
behaviours, and communication) equally cited
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Competence stems
Consumer Survey - patients and relatives
21 items free text ? 3 key themes
35 Keyword categories ? 17 Domains
Summaries refined ? Competence stems
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Constructing a Competence statementfrom each stem
Context By the end of ICM specialist
training, the trainee Level of expertise
...describes... ...demonstrates...
...performs... ...manages... Competenc
e stem ...endotracheal intubation
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Generic levels of expertise

(Demonstrates... Performs... Manages....
Conducts...)
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Nominal Group Tasks
For each competence stem the NG 1. Agreed the
minimum level of expertise Then 2. Rated
the importance of the competence statement
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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 gt4)
• 50 moderate importance (mean 3 - 4)
• 8 low importance (mean lt3)

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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

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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

• 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

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Outcome Competence statements

• Common themes merged reduce repetition, remove
  discrepancies allow for differences in local
  practices

• 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

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Building the syllabus

• Database of syllabus elements (gt2000) - 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

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12 Domains
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Example of a Domain...
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Example of syllabus elements...
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The next 12 months....

• Developing assessment benchmarks
• Identifying assessment methods guidelines for
  their use
• Assessment WG
• Identifying existing educational resources to
  support acquisition of competencies
• Educational Resources WG

PHASE 3
PHASE 4
Development of electronic framework to
link competencies, syllabus, assessment
guidelines educational resources...
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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.