Competence in Decision Making: Setting Performance Standards for Critical Care.

Area of Science:

• Medical Education
• Patient Safety
• Critical Care Medicine

Background:

• Effective decision-making by healthcare professionals is crucial for intensive care unit (ICU) patients.
• Establishing competence standards for critical care decision-making is challenging but vital for patient safety.
• Simulation-based assessment is proposed as a method to evaluate decision-making competence.

Purpose of the Study:

• To test the hypothesis that simulation can effectively assess decision-making competence in critical care trainees.
• To develop and apply a standard-setting method for deriving performance standards in simulated ICU scenarios.

Main Methods:

• A standard-setting approach was used to derive cut scores for 16 simulated ICU decision-making scenarios.
• Critical care experts (panelists) reviewed trainee performances in simulated scenarios.
• Panelists judged trainee readiness for independent decision-making, and this was correlated with assessment scores to set standards.

Main Results:

• Panelists' judgments of trainee readiness were positively associated with performance scores across all 16 scenarios.
• This association allowed for the derivation of scenario-specific performance standards.
• The method successfully identified trainees ready or not ready for independent ICU decision-making.

Conclusions:

• Standard-setting techniques can establish minimum competence standards for high-stakes decision-making.
• The simulation-based approach effectively identifies critical care providers ready for independent decision-making.
• This methodology can assure stakeholders of clinician competence, with further validation needed in other domains.