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Available online 6 January 2025
Effect of a competence based medical education program on training quality in Intensive Care Medicine. COBALIDATION TRIAL
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Álvaro Castellanos-Ortegaa,
Corresponding author
castellanos_alv@gva.es

Corresponding author.
, María Jesús Broch Porcara, Diego Palacios-Castañedab, Vicente Gómez-Telloc, Miguel Valdiviab, Carlos Vicenta, Isabel Madrida, Nuria Martinezb, Manuel José Párragad, Elena Sanchoa, María del Castillo Fuentes-Durae, Rafael García-Rosf
a Intensive Care Department. Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Intensive Care Department, Hospital Puerta de Hierro-Majadahonda, Spain
c Intensive Care Department, University Hospital Moncloa, Madrid, Spain
d Intensive Care Department, Hospital Universitario Morales Meseguer, Murcia, Spain
e Department of Methodology of the Behavioral Sciences, University of Valencia, Spain
f Department of Developmental and Educational Psychology, University of Valencia, Spain
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Received 02 August 2024. Accepted 22 September 2024
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Tables (5)
Table 1. Criteria to determine de levels of competence considered in the study.
Table 2. Hospitals participants (ICU Departments), number of residents/year accredited, number of residents participants in the baseline and in the final OSCE, number of formative assessments performed and number of CoBaTrICE competences assessed in each resident of the CoBaTrICE group.
Table 3. Final OSCE. Inter-rater reliability: Intraclass Correlation Coefficient for the total scores given by the raters, Kappa for the Competence Level achieved.
Table 4. Number of performances, total scoring, percentage of CEPE and CNEPE completed, and competency level achieved in both groups CoBaTrICE (experimental group) and traditional (control group) in the five final OSCE scenarios.
Table 5. Distribution of residents by the levels of competence achieved in the OSCE: CoBaTrICE group, control group, and total participants.
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Abstract
Objectives

The main objective of this study was to evaluate whether the implementation of CoBaTrICE (Competency-Based Training in Intensive Care Medicine in Europe) provides higher levels of competency in comparison with the current official time-based program in Intensive Care Medicine in Spain. Secondary objectives were: 1) To determine the percentage of critical essential performance elements (CEPE) accomplished, 2) To determine compliance with workplace-based assessments (wba).

Design

Multicenter cluster randomized trial.

Setting

Thirteen Spanish ICU Departments.

Participants

Thirty-six residents

Intervention

The implementation of CoBaTrICE included: (1) Training the trainers; (2) Wba; (3) The use of an electronic portfolio. The level of competency achieved by each participant was determined by a simulation-based Objective Structured Clinical Exam (OSCE) performed at the end of the 5th year of training period.

Main variables of interest

Total scoring in the five scenarios, CEPE completed, level of competency (1–5) achieved.

Results

A total of 119 performances from 26 residents (17 from CoBaTrICE group and 9 from control group) were analyzed in the OSCE. CoBaTrICE residents´ achieved higher levels of competency [2 (1−5) vs. 2 (1−3), p = 0.07) and higher percentages of CEPE´s accomplishment than the control group (78% vs. 71%, p = 0.09).

Conclusions

The CoBaTrICE group showed a better performance trend in comparison to the control group, but the differences were not statistically significant. Since the number of Wba performed was low, additional research is needed to determine the potential superiority of CoBaTrICE.

Keywords:
Training
Assessment
Simulation
Competency-based education
Resumen
Objetivos

El objetivo principal del estudio fue evaluar si la implementación de CoBaTrICE (Competency-Based Training in Intensive Care Medicine in Europe) proporciona niveles de competencia superiores al programa oficial español actual de medicina intensiva basado en rotaciones. Objetivos secundarios: 1) determinar la proporción de elementos críticos de desempeño esenciales (CEPE) completados, 2) determinar el cumplimiento de CoBaTrICE.

Diseño

Ensayo multicéntrico aleatorio de tipo conglomerado.

Ámbito

Trece departamentos de medicina intensiva españoles.

Participantes

Treinta y seis residentes.

Intervención

La implementación de CoBaTrICE incluyó: (1) curso de feedback para tutores; (2) realización de evaluaciones formativas en la UCI; (3) uso de un portafolio electrónico. El nivel de competencia de cada participante se determinó mediante un examen clínico objetivo estructurado (ECOE) basado en simulación realizado al final de la residencia.

Principales variables de interés

Puntuación total en los cinco escenarios, CEPE completadas, nivel de competencia alcanzado (1 a 5).

Resultados

Se analizaron un total de 119 actuaciones de 26 residentes (17 del grupo CoBaTrICE y 9 del grupo control). Los residentes de CoBaTrICE consiguieron niveles más altos de competencia [2 (1–5) vs. 2 (1–3), p = 0,07] y mayores porcentajes de CEPE que el grupo control (78% vs. 71%, p = 0,09).

Conclusiones

El grupo CoBaTrICE mostró una tendencia a un mejor desempeño que el grupo control, pero las diferencias no fueron estadísticamente significativas. Dado que el número de evaluaciones realizadas fue muy bajo, se necesita investigación adicional para determinar la posible superioridad de CoBaTrICE.

Palabras clave:
Formación
Evaluación
Simulación
Formación en competencias

Article

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