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An international survey of training in adult intensive care medicine

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Abstract

Objective

The aim of this international survey of training in adult intensive care medicine (ICM) was to characterise current structures, processes, and outcomes to determine the potential for convergence to a common competency-based training programme across national borders. This survey is the first phase of a 3 year project which will use consensus methods to build an international competency-based training programme in ICM in Europe (CoBaTrICE).

Methodology

A survey by questionnaire, email, and direct discussion was undertaken with national ICM representatives from seven geographical regions.

Results

Responses were obtained from 41 countries (countries which share common training programmes were grouped together; n=38). Fifty-four different training programmes were identified, 37 within the European region; three (6%) were competency-based. Twenty (53%) permitted multidisciplinary access to a common training programme; in nine (24%) training was only available within anaesthesia. The minimum duration of ICM training required for recognition as a specialist varied from 3 months to 72 months (mode 24 months). The content of most (75%) ICM programmes was standardised nationally. Work-based assessment of competence was formally documented in nineteen (50%) countries. An exam was mandatory in twenty-nine (76%).

Conclusion

There are considerable variations in the structures and processes of ICM training worldwide. However, as competency-based training is an outcome strategy rather than a didactic process, these differences should not impede the development of a common international competency-based training programme in ICM.

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Author information

Authors and Affiliations

  1. University Department of Anaesthesia and Intensive Care, N5 Queen Elizabeth Hospital, Edgbaston, Birmingham, B15 2TH, UK

    H. Barrett & J. F. Bion

Authors
  1. H. Barrett
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  2. J. F. Bion
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Corresponding author

Correspondence to H. Barrett.

Additional information

The authors wrote this article on behalf of the CoBaTrICE Collaboration. For details see Appendix 3

Electronic Supplementary Material

Appendices

Appendix 1: Characteristics of a competency-based training programme

Components

  • Clearly articulated competency statements

  • Curriculum defined in terms of knowledge, skills, and attitudes

  • Criterion-referenced assessment guidelines

  • Supporting materials to assist workplace implementation (trainer/trainee)

Characteristics

  • Programme is learner-centred

  • Programme directed at a specific role or setting

  • Competencies are verified by expert practitioners and made public in advance

  • Training is based in the workplace or similar environment

  • Training integrates theory and practice

  • Trainees identify their learning needs with the support of the trainer; competencies which have been attained and maintained in other programmes need not be repeated

  • Teaching methods and educational processes are flexible

  • Guidelines for assessing competence in the workplace include assessment criteria and conditions. The standard required for competent performance is made explicit

  • Trainees progress through the programme at their own rate by demonstrating the attainment of specified competencies

  • Satisfactory completion of training is based on the achievement of all specified competencies

(Derived from [17, 18, 19, 20])

Appendix 2: Models of ICM training

Supra-speciality model

  • Multidisciplinary access to a single common ICM programme during or after training in a range of base specialities

  • Common national curriculum

  • Dual specialist certification (accreditation) in a base speciality and in ICM. ICM specialist certification alone is not permitted

Multiple sub-speciality model

  • ICM training ‘owned’ by multiple parent specialities—access limited to trainees within the respective parent discipline

  • Multidisciplinary access during or after base training

  • Each speciality has its own national ICM curriculum

  • Dual certification or base speciality certification which includes ICM

Single sub-speciality model

  • ICM training ‘owned’ by one parent speciality—access limited to trainees within this speciality either during or after base training

  • No multidisciplinary access

  • Dual certification or base speciality certification which includes ICM

Primary speciality

  • Base speciality. Access directly after undergraduate training

  • Specialist certification (accreditation in ICM only)

(Adapted from [5])

Appendix 3: Contributors

Principal authors

H. Barrett, CoBaTrICE Research nurse; J.F. Bion, CoBaTrICE Project lead.

On behalf of the CoBaTrICE Collaboration

Steering committee partners

G. Libreau; A. Augier (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 (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); 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); H.Flatten (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).

Sponsors

CoBaTrICE is supported by a grant from the European Union, Leonardo da Vinci programme. Additional supporter: GlaxoSmithKline

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Barrett, H., Bion, J.F. An international survey of training in adult intensive care medicine. Intensive Care Med 31, 553–561 (2005). https://doi.org/10.1007/s00134-005-2583-7

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