Introduction to Competencies
The CoBaTrICE competencies define the minimum standard of knowledge, skills and attitudes required for a doctor to be identified as a specialist in intensive care medicine (ICM). They have been developed with the intention of being internationally applicable but able to accommodate national practices and local constraints. They comprise 102 competence statements grouped into 12 domains.
Cobatrice Domains
Level of expertise and supervision
We have identified three level of expertise at which competencies may be acquired. Unless otherwise indicated, by the end of specialist training, competencies should be performed at a level of independent practice (this may include the capacity to supervise others or direct a team) with indirect supervision provided by a trainer. Where competencies refer to being performed "under supervision" this implies direct supervision. The CoBaTrICE competencies indicate the minimum standard, and in many instances a higher level of expertise (i.e. a lower level of supervision) is both possible and appropriate.
Domain 1 RESUSCITATION
The point of first contact with an acutely ill, deteriorating, or collapsed patient requires clinicians to take action to prevent or correct physiological deterioration despite uncertainty about causation and the underlying diagnosis. Meeting this challenge - action in uncertainty - demands a structured approach to patient management, exemplified by the resuscitation algorithms, but less well developed for the non-arrested acutely ill patient.Domain 2 DIAGNOSIS
It is very easy to acquire large amounts of data in modern medical practice. The challenge is to acquire appropriate data and convert it into information, essential steps on the pathway to diagnosis and treatment. Monitoring devices combine the functions of clinical investigation with surveillance. Clinical investigations are forms of hypothesis testing; they bring burdens and occasional risks for patients, as well as additional costs and work for the investigating clinician and laboratory staff. Their utility, safety and accuracy must be balanced against these factors.Domain 3 DISEASE MANAGEMENT
Diagnostic accuracy determines therapeutic specificity. Although in the early phases of managing an acutely ill patient, physiological safety and support are the main issues, making the correct diagnosis and providing the right treatment will determine the patients outcome. Disease management therefore requires skills in integrating clinical information with laboratory data, and applying 'best practice' guidelines promptly and effectively. It also involves regular clinical review with revision of diagnostic possibilities and modification of treatment according to patient response.Domain 4 INTERVENTIONS
Skilled organ-system support including appropriate therapeutic interventions is the 'housekeeping' of intensive care practice, a necessary - but in itself insufficient - requirement for promoting survival from critical illness. The practical procedures associated with organ system support are considered in the next section.Domain 5 PROCEDURES
Practical procedures underpin all forms of organ system support. All these competencies will include, where relevant, attention to:Domain 6 PERI-OPERATIVE CARE
Acutely ill patients may present with medical, or surgical problems, or both. The complications of critical illness do not respect speciality boundaries. Perioperative care requires multidisciplinary collaboration, and often provides opportunities for preventative intensive care.Domain 7 COMFORT AND RECOVERY
The compassionate care of patients and families is a fundamental duty of any clinician, which is given particular emphasis by the special circumstances of critical illness. The process of rehabilitation starts in intensive care and is continued for many months - sometimes years - following discharge from hospital. This journey to recovery requires attention to both the physical and the psychological consequences of critical illness.Domain 8 END OF LIFE CARE
Death is inevitably a managed, not a 'natural' process in intensive care. The manner in which it is conducted may affect the survivors - family and staff - for the rest of their lives. Treatment limitation or withdrawal does not mean denial of care; patients should not suffer, and, where possible, their wishes should be determined and respected.Domain 9 PAEDIATRIC CARE
These competencies are those expected of a practitioner of adult intensive care medicine, not a paediatric intensivist or neonatologist. Adult intensivists may be called upon to provide immediate care for the acutely ill child while awaiting transfer to a paediatric centre.Domain 10 TRANSPORT
Critically ill patients may require intra- or inter-hospital transfer for clinical reasons. The principles are the same for both circumstances. Competence in aero-medical transfers is not a specific requirement though they may be used for competence acquisition and assessment if local circumstances permit.Domain 11 SAFETY AND MANAGEMENT
Error in healthcare often creates two victims - the patient, and the clinician who is usually the terminal component in an unsafe healthcare system. Creating safer systems may require changes in structures and resources, but always involve improvements in processes and organisation of care.Domain 12 PROFESSIONALISM
A professional is someone with special expertise who gains the the privilege of self-regulation through vocation and service, high ethical standards, critical self-appraisal, and personal development. Professionalism includes the capacity for clinical judgement (the translation of data into knowledge and knowledge into appropriate actions). These distinguishing attitudes and behaviours can be evaluated in terms of communication skills, professional relationships, and personal governance (personal standards, self-development, insight, and self-control).Introduction to Syllabus
The CoBaTrICE syllabus comprises the aggregate of all the knowledge, skills, behaviours and attitudes required for each competence. In this section it is divided into 13 sections: 12 domains plus basic sciences. This format inevitably results in repetition with the same topic appearing in more than one domain and linked to multiple competencies. Similarly there is some cross-over between the knowledge and basic sciences, and knowledge and skills lists.
The syllabus required for each competence can be viewed by following the Syllabus links in the competencies section.
A PDF of each format of the complete syllabus is available to download at the end of this page.
The syllabus can be used by trainee's and trainer's to aid reflective learning, formal teaching and to guide some aspects of assessment. The syllabus is presented as tables to allow trainees to track the progression of their learning if they wish. It is not intended that these tables be used as checklists for the assessment of competence. No trainee can be expected to have a comprehensive knowledge of every single aspect of the syllabus.
Note that the "Resources" that are here included, have not been updated in the recent years. An updated collection of useful resources will be available soon as part of the ESICM Academy (for more details, see www.esicm.org).