Cardiopulmonary Resuscitation Training and Reinforcement: A Bulwark against Death

How to cite this article: Sinha S. Cardiopulmonary Resuscitation Training and Reinforcement: A Bulwark against Death. Indian J Crit Care Med 2024;28(4):317-319.

Standard setting for orthopaedic trauma competencies in postgraduate specialty training- catching those falling behind the curve

BACKGROUND

The Curriculum for Trauma and Orthopaedics focuses on producing competent Day-One Consultants. However, the expected development trajectory is not clear. It is important, yet difficult to objectively identify trainees who are "falling behind". This project proposes practical, consensus-based thresholds of Operative Trauma Competence at each Waypoint stage of training.

METHODS

32 trainers and 73 trainees in one Deanery were identified. The trainers and trainees were asked their PBA level expectation of a trainee at ST4, ST6 and ST8 for nine trauma competencies. Lower quartile values were calculated providing thresholds.

RESULTS

53 (72%) trainees and 22 (69%) trainers responded. At ST8, the lower quartile threshold was level 4 for all procedures. At ST6, three operation groups became apparent: Group 1 (hip hemiarthroplasty, Dynamic hip screw; k-wire distal radius fracture and Weber C Ankle open reduction, internal fixation (ORIF)) Group 2 (Tibial Nail; Olecranon Tension band wire, ORIF radial shaft; distal radius plate fixation)- Group 3 (supracondylar fracture fixation)Threshold levels for procedures were: Group 1- 4a; Group 2-3b and Group 3- 3a.At ST4, there was more variation and spread in responses, however, expectations could still be similarly grouped: Group 1- 3a; Group 2- 2b and Group 3- 2a.

CONCLUSION

In an increasingly competency-based training environment we provide tangible thresholds for expectations of orthopaedic trainees' progression and development. We identified two groups: basic trauma (Group 1 where level 4 competencies should be attained by ST6) and intermediate trauma (Groups 2 and 3 where level 4 competencies should be attained by ST8.).

Peripheral nerve surgical competency in plastic surgery and neurosurgery residents

OBJECTIVE

To assess the case volume and self-perceived competence of current mandatory skills in peripheral nerve surgery.

DESIGN

Cross sectional survey based study examining case volume and self-reported competence in peripheral nerve surgery.

SETTING

Canadian Neurosurgery and Plastic Surgery accredited residency programs PARTICIPANTS: All Canadian Neurosurgery and Plastic Surgery senior trainees (PGY 3+) invited to participate RESULTS: Much variability exists in both exposure to cases and perceived senior resident competence for both plastic and neurosurgery residents. Confidence in surgical ability as perceived competency is lower in trainees for more advanced peripheral nerve procedures. Self- reported confidence increased with post-graduate experience.

CONCLUSIONS

Overall, the findings in this study highlight the importance of increasing operative experience in complex peripheral nerve surgery among surgical residents.

Entrustable professional activities (EPAs) for postgraduate competency based intensive care medicine training in the Netherlands: The next step towards excellence in intensive care medicine training

INTRODUCTION

The Competency Based Training in Intensive Care Education (CoBaTrICE) programme developed common standards of ICM training by describing competencies of an intensivist. Entrustable Professional Activities (EPAs) of Intensive Care Medicine (ICM) (EPAsICM) are presented as a new workplace-based assessment tool in competency-based training of intensivists. EPAs are activities to be entrusted to a trainee once he (or she) has attained competence. EPAs emphasise the role of trust between trainees and supervisors. EPAs bridge the gap between competencies and competence.

METHODS

An expert panel of ICM (vice)programme directors and intensivists in The Netherlands integrated the CoBaTrICE and CanMEDS competencies into EPAsICM. Comment and feedback was sought from other ICM programme directors and educational experts and processed in the final version of EPAsICM before implementation in the Dutch ICM training programme.

RESULTS

A list of 15 EPAsICM are considered to reflect the spectrum of clinical practice while incorporating the competencies of CoBaTrICE and CanMEDS. The grading system is designed as a 5-point entrustment scale based on the amount of supervision a trainee needs, aligning with daily judgement of trainees by intensivists.

CONCLUSION

EPAsICM is an assessment tool that formalises entrustment decisions and can be a valuable addition in international ICM training.