Training and assessment of competency in the transfer of critically ill patients

Abstract

In their recent letter, Spencer and colleagues [1] noted a decade's worth of requirements and guidelines for the transfer of the critically ill patient [2, 3]. They also comment that the CCST in Anaesthesia requires competence in such transfers [4] and that many of the trainees they surveyed had little such experience when first transferring a critically ill patient. Steps One and Two of Training in Intensive Care Medicine also require the demonstration of such competencies [5]. They conclude by hoping that their measures will increase the satisfaction of trainees and ensure competency amongst SHOs undertaking transfers. Their comments mirror our experience in the Northern and Yorkshire Regional Health Authority. Similar discussion combined with personal anecdote of intra- and interhospital transfer led to the development of a 2-day training course in 1998: ‘Training for Transfer’. The course aimed to increase awareness of problems relating to the transfer of critically ill patients and to expand the knowledge of participants in terms of pathophysiological, clinical, practical, communication and ethical issues. The educational setting is informal, away from the Critical Care area. It attempts to foster a multidisciplinary approach. The participants (24 at a time) are mainly doctors and nurses but have included operating department practitioners, paramedics and physiotherapists. A course manual is sent to candidates 6 weeks before the start. The early part of the course is a series of interactive lectures and small group teaching. The latter part of the course is problem-based small group teaching and scenario based situations. Assessment occurs in two parts. Firstly, the candidates sit multiple-choice examinations. The precourse test assesses background knowledge and the level of self-directed learning. A second test occurs on the final day as a means of further such assessment. Candidates also have to apply acquired knowledge to OSCEs and role-play scenarios. To date there have been 17 courses. Post-course evaluation has been positive and qualitatively it provides a number of advantages; education for competence, problem-based learning, integration into a critical care curriculum (for doctors and nurses) and quality control through regular review of the course content and structure. Awareness has grown in the Region and course providers have returned to base hospitals to educate colleagues. A 1-day course for nursing staff (excluding the assessment element) now runs within some of the Region's hospitals. At a quantitative level, data has been difficult to assimilate but evidence exists to suggest that aspects of interhospital transfer in our Region have improved since the introduction of the course. Consecutive audit has demonstrated increased use of appropriate drugs, invasive monitoring and capnography [6, 7]. The level and standard of transfer documentation has improved in transfers from some centres within the Region [8]. In summary, as a move towards competency-based training in transferring critically ill patients we would suggest that assessing candidate performance in OSCEs and scenarios would supplement measures outlined by Spencer et al. such as ‘Consultant Supervised’ transfer. If these intuitive and qualitative advantages are to be justified, an ongoing review of accurate transfer audit data is necessary. If the issues raised are to be advanced further, is there scope for increased collaboration of such courses at a national level?