Competency-Based Training Efforts Take New Steps
The Society of Critical Care Medicine (SCCM) hosted a meeting in November to discuss the future of competency-based training in the United States, inviting key U.S. and international participants to share perspectives and insights. Representatives from the European Society of Intensive Care Medicine (ESICM), the American Board of Anesthesiology, the American Board of Internal Medicine (ABIM), the American Board of Pediatrics, the American Board of Surgery, the American Board of Emergency Medicine, the Accreditation Council for Graduate Medical Education, the American College of Chest Physicians (ACCP), and the American Thoracic Society (ATS) attended the meeting in addition to representatives from the SCCM leadership. The group discussed the identification of a set of core competencies for U.S. intensivists based
on information offered during three informative presentations:
• Former SCCM president Timothy Buchman, MD, PhD, FCCM, U.S. reporter for the Competency-Based Training in Intensive Care Medicine in Europe (CoBaTrICE) project, summarized the history of critical care as well as the meeting objectives.
• ESICM representatives Julian Bion, MD, FRCP, FRCA, and Hannah Reay, discussed the CoBaTrICE project in detail, outlining the processes, framework, achievements and goals as well as lessons learned.
• Polly Parsons, MD, shared reports from the Multi-Society Task Force for Development of Competencies in Pulmonary and Internal Medicine Based Critical Care Medicine.
Learning from European Partners
The CoBaTrICE project began in October 2003 with the overarching goal of developing a strategy that would ensure that an intensivist trained in one European country possesses the same core skills and abilities as an intensivist trained in another, guaranteeing a common standard of clinical competence. After much collaboration and input from the healthcare community, patients and families, an expert panel was convened to refine descriptions for current curriculum-based training and to match educational resources and evaluative tools with each of 102 final core competencies.
Each competency is independent of primary specialty or national origin, and the CoBaTrICE definitions of core competencies were designed to avoid disruption of existing training schemes. Professional disciplines are encouraged to develop and validate additional competencies that may be important to regional or specific practice domains. The CoBaTrICE focus was never to describe all domains of expertise, but rather those minimum core competencies that reasonably can be expected of any critical care practitioner in Europe.
Overall, the CoBaTrICE competencies have been well received by the intensive care community in Europe and other parts of the world, as many already are using this information toward a more uniform standard of care for critically ill and injured patients Studies have found shared competencies simplify the training process for trainees, trainers, and accrediting and regulatory agencies and improve the reliability of care for patients and families. The CoBaTrICE Web site, www.cobatrice.org, provides links to various competencies that can be searched by knowledge elements; users can find relevant educational resources and evaluate competencies using a range of assessment tools. These successes, Bion said, show that harmonization across countries and cultures is possible. His report painted a hopeful picture for those interested in creating U.S. competencies, but much work lies ahead.
Progress in the United States
Building on lessons learned from the CoBaTrICE project, a group of U.S. partners investigated competency-based training on a smaller scale, focusing primarily on the needs of trainees and practitioners coming through the internal medicine pathway. The Multi-Society Task Force for Development of Competencies in Pulmonary and Internal Medicine Based Critical Care Medicine was convened by the ABIM after the board decided to recognize critical care medicine as a distinct subspecialty and not an added qualification.
The task force convened in fall 2006 with representatives from SCCM, ABIM, ACCP, ATS and the Association of Pulmonary and Critical Care Medicine Program Directors (APCCMDP). As chair, Parsons said she deliberately did not focus on which organizations members were representing; she wanted all members to stay focused on the mission to create standards for competency-based training, certifications and credentialing. The group started by evaluating requirements and resources from the Accreditation Council for Graduate Medical Education, the HERMES Critical Care Group, ABIM and CoBaTrICE and by categorizing specific areas of knowledge for critical care medicine: medical knowledge, patient care, systems-based practice, communications and interpersonal skills, practice-based learning and improvement and professionalism. Each competency was rated for its importance, and tools and resources for evaluation were identified. The task force approved recommended competencies for internal medicine-based critical care, a measurement table and a report of the process; all were submitted to leaders of SCCM, ACCP, APCCMPD, and ATS for review.
The new group that gathered in November agreed to examine the processes, concepts and competencies developed by the multi-society task force and to explore how these might be extended to all critical care practitioners in all disciplines. “We should look at what lies at the intersection of all disciplines – the core,” Buchman said, “so that patients are guaranteed a minimum competency regardless of the primary specialty of the intensivist looking after them.”
Taking the Next Steps, Together
As with most aspects of critical care, one of the most important tools in creating a competency-based program is teamwork. This was true of the European team, which brought together an international group of more than 80 national coordinators and deputies to represent training organizations in 42 countries. It also was true of the multi-society task force, which put aside affiliation in the interest of a common goal. SCCM president Frederick Ognibene, MD, FCCM, stressed the importance of this type of teamwork, saying the November meeting was a positive first step in building a unified front. Ognibene felt it was vital that members of the critical care community be seen as the leaders of change in this arena. “We need to be the drivers in this effort before groups outside the critical care community start making decisions for us,” Ognibene said. “It will take a lot of work, but the critical care community can come together on this important issue.”
Bion also praised the collaborative nature of the assembled group. “By focusing on content and not politics, many have come to work together. We are very impressed by the work done here today, and I hope we will be able to share information and learn from one another.”
The need to develop competency-based training within the United States touches on many other important issues, such as the critical care workforce shortage. The critical care community must ensure today that the next generation of practitioners is plentiful and well trained. The Society is proud to join with many partners in its mission to develop core competencies to ensure quality critical care for patients and families. SCCM’s members will be kept up to date on developments and progress in this effort to produce core competencies to help train this and future generations of intensivists in the United States and worldwide.
