Intensive Care Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain.
Med Intensiva (Engl Ed). 2022 Sep;46(9):491-500. doi: 10.1016/j.medine.2022.01.001.
The current official model of training in Intensive Care Medicine (ICM) in Spain is based on exposure to experiences through clinical rotations. The main objective was to determine the level of competency (I novice to V independent practitioner) achieved by the residents at the end of the 3rd year of training (R3) in ICM through a simulation-based OSCE. Secondary objectives were: (1) To identify gaps in performance, and (2) To investigate the reliability and feasibility of conducting simulation-based assessment at multiple sites.
Observational multicenter study.
Thirteen Spanish ICU Departments.
Thirty six R3.
The participants performed on five, 15-min, high-fidelity crisis scenarios in four simulation centers. The performances were video recorded for later scoring by trained raters.
Via a Delphi technique, an independent panel of expert intensivists identified critical essential performance elements (CEPE) for each scenario to define the levels of competency.
A total of 176 performances were analyzed. The internal consistency of the check-lists were adequate (KR-20 range 0.64-0.79). Inter-rater reliability was strong [median Intraclass Correlation Coefficient across scenarios: 0.89 (0.65-0.97)]. Competency levels achieved by R3 were: Level I (18.8%), II (35.2%), III (42.6%), IV/V (3.4%). Overall, a great heterogeneity in performance was observed.
The expected level of competency after one year in the ICU was achieved only in half of the performances. A more evidence-based educational approach is needed. Multiple center simulation-based assessment showed feasibility and reliability as an evaluation method of competency.
COBALIDATION. NCT04278976. (https://register.
gov).
西班牙重症监护医学（ICM）培训的现行官方模式基于通过临床轮转获得经验。主要目的是通过基于模拟的客观结构化临床考试（OSCE）确定在 ICM 培训的第 3 年结束时（R3）住院医师达到的能力水平（从新手 I 到独立执业者 V）。次要目标是：（1）确定绩效差距，（2）研究在多个地点进行基于模拟的评估的可靠性和可行性。
观察性多中心研究。
西班牙 13 个 ICU 病房。
36 名 R3。
参与者在四个模拟中心进行了五个 15 分钟的高保真危机情景。为了进行评分，对这些表现进行了视频录制，并由受过训练的评分员进行评分。
通过德尔菲技术，一组独立的专家重症医学专家确定了每个情景的关键基本绩效要素（CEPE），以定义能力水平。
共分析了 176 次表现。清单的内部一致性是足够的（KR-20 范围为 0.64-0.79）。评分者间的可靠性很强[跨情景中位数组内相关系数：0.89（0.65-0.97）]。R3 达到的能力水平是：一级（18.8%），二级（35.2%），三级（42.6%），四级/五级（3.4%）。总体而言，观察到表现存在很大的异质性。
在 ICU 工作一年后，只有一半的表现达到了预期的能力水平。需要更基于证据的教育方法。基于模拟的多中心评估显示了作为能力评估方法的可行性和可靠性。
COBALIDATION。NCT04278976。（https://register.clinicaltrials.gov）。
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