Clinical PotpourriAre graduated intensivists prepared for practice? A case study from The Netherlands
Introduction
Competency-based education (CBE) has been adopted to better respond to future challenges in health-care and to meet societal requirements [1], [2]. In intensive care medicine (ICM), 43 national societies have collaborated to develop a competency framework and common standards for postgraduate training within the “Competency Based Training in Intensive Care medicine for Europe collaboration” (CoBaTrICE) [3], [4]. These standards should harmonize training in ICM without interfering with specific national regulations, allow for free movement of intensivists across Europe, and ensure high quality education in ICM.
Most research on the development of CBE in ICM has focused on international standards, structures, processes and assessment, or on the patients' views on what makes a good intensivist [5], [6], [7]. In contrast, only few studies have evaluated the content of ICM training programmes. According to Bion & Rothen [8], the development of a competency framework is “no more than a product specification”. They posit that the next phase in research on CBE in ICM should aim at examining whether better training will result in better specialists delivering better care.
Quality of training and medical specialist performance are difficult to measure, predominantly due to the diverse or conflicting conceptions of what constitutes a good doctor [9]. Each phase in medical training should however strive to prepare trainees optimally for the next phase. Therefore, a useful approach to study the quality of ICM training is to evaluate whether newly graduated intensivists feel sufficiently prepared by their training program for the tasks they have to perform in independent practice. This approach may reveal specific demands from practice for which graduate intensivists feel insufficiently prepared and hence provide valuable information for further improvements in ICM training and its alignment with independent practice. Although the introduction of CBE in medical education was mainly driven by an intention to adhere to societal requirements and to implement generic competencies (e.g. communication, collaboration and leadership) more strongly [1], research within other disciplines has shown that graduates do not feel optimally prepared for tasks which require generic competencies like leadership and professionalism [10]. There is however no data available which shows how well competency-based ICM training programmes prepare their trainees for practice.
The Netherlands was one of the first countries to adopt the CoBaTrICE framework in ICM training. Under responsibility of the Joint Intensivists Committee (GIC) a syllabus with a translated list of all ICM competencies was developed which is now being used by all nine ICM training institutes in the Netherlands for many years. To further harmonize training programmes, the GIC organizes monthly educational seminars for ICM fellows and performs regular audits to evaluate the quality and content (implementation of CoBaTrICE) of all ICM training programmes. As such all ICM fellows in the Netherlands receive a comparable training program. Given the extensive experience with CoBaTrICE and the harmonization of training programmes, the Netherlands provides a unique opportunity to evaluate CBE in ICM [11].
As a specific feature of ICM training, a supraspecialty model (in which completion of several postgraduate training programmes provides access to ICM training) applies to 60% of the European countries [6]. While anaesthesiology and internal medicine are the base specialties in most countries, other base specialties include pulmonary medicine, cardiology, surgery and neurology. Due to this multidisciplinary background, a specific challenge for ICM training is to provide every trainee with a program that fits his or her background while ensuring a certain quality standard at the end of training. Accordingly our study evaluates how well ICM trainees feel prepared for practice and whether trainees from different base specialties feel prepared for practice differently.
Section snippets
Context and setting
This study was performed in the Netherlands where ICM training programmes are being offered by eight university medical centers and one large general teaching hospital. Access from several primary specialties (internal medicine, pulmonary medicine, anaesthesiology, surgery and neurology) can be gained into a common national 2-year training programme.
Participants
The program leaders of the 9 ICM training programmes in the Netherlands were approached to provide contact information of intensivists who had
Descriptives
Of the 205 intensivists invited, 91 completed the questionnaire (response rate 45%). There were 38 male (42%) and 53 female respondents (58%). Mean age was 39 (SD 3.4) years, and respondents were on average licensed as an intensivist for 3 years (SD 1.4). Most respondents had their base specialty in anaesthesiology (43%) and internal medicine (33%), with few respondents from other base specialties: cardiology (2%), surgery (3%), pulmonology (3%) and neurology (1%). 46 respondents (51%) worked
Discussion
The results of this study show that recently licensed intensivists feel well prepared for the majority of the tasks that constitute independent practice. However there are numerous tasks for which they feel less well equipped by their ICM training programmes. In line with comparable studies in other disciplines [10], [14], [15], intensivists feel well prepared for tasks directly related to patient care, but preparedness scores are considerably lower for tasks that require more general
Conclusions
In line with findings in others specialties [10], graduate intensivists generally feel well prepared for independent ICM practice, but they feel insufficiently prepared for tasks related to leadership and management, science, and professional development. These results call for a re-evaluation and update of the current (Dutch) CoBaTrICE framework. Although the medical expert role should evidently remain the core of ICM training, ICM training frameworks should expand its focus to the generic
Take home message
Although graduated intensivist feel well prepared for the majority of the tasks of independent practice, they report deficiencies regarding the preparation for tasks related to leadership, management, science and professional development. Therefore ICM training programmes should address these generic roles of independent practice more explicitly.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interest
None.
Acknowledgements
We would like to acknowledge all programme leaders of ICM training programmes in the Netherlands for their participation to our study.
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