Development and Validation of the Denver Critical Illness Intubation Entrustment (D-CITE) Tool

Area of Science:

• Critical Care Medicine
• Medical Education
• Simulation-Based Training

Background:

• Intensive Care Unit (ICU) intubations are high-risk procedures demanding specialized skills.
• Current training for ICU intubations lacks standardized assessment tools for adult settings.
• There is a need for validated methods to evaluate proficiency in adult ICU intubations.

Purpose of the Study:

• To develop and validate a novel entrustment-based assessment tool for adult ICU intubation skills.
• To establish the validity and reliability of the Denver Critical Illness Intubation Entrustment (D-CITE) Tool.
• To provide an objective measure for assessing trainee competence in simulated ICU intubation scenarios.

Main Methods:

• A modified Delphi study involving 19 multidisciplinary experts identified key intubation microskills.
• The Denver Critical Illness Intubation Entrustment (D-CITE) Tool was developed based on expert consensus.
• The D-CITE Tool was validated using simulation with 20 participants, employing Cronbach's alpha, ICC, EFA, and Rasch modeling.

Main Results:

• The D-CITE Tool, comprising 10 microskills and a global entrustment assessment, was finalized.
• The tool demonstrated high reliability (Cronbach's alpha = 0.97) and good inter-rater reliability (ICC = 0.77).
• Factor analysis confirmed the D-CITE Tool assesses intubation competency as a single construct, with Rasch modeling showing appropriate fit.

Conclusions:

• A novel, reliable, and valid entrustment tool (D-CITE) was developed for assessing adult ICU intubation skills in simulation.
• The D-CITE Tool provides a robust measure for evaluating trainee progress toward competence.
• Future research should focus on validating the D-CITE Tool in real-world clinical settings.