Promoting mental health in intensive care unit onboarding: a consensus-based iterative development of a...

Healthcare professionals in intensive care units face substantial psychological stress, yet structured educational approaches to promote mental health during early training remain underdeveloped. While current recommendations advocate early integration of psychosocial support into onboarding, they have not been translated into competency-based educational frameworks aligned with modern health professions education.

To develop a competency-based educational framework for ICU onboarding that integrates mental health promotion into structured learning objectives across knowledge, reflection, and action domains.

A mixed-methods design was applied, combining a structured consensus process with competency-based curricular mapping. Guiding questions were iteratively refined using a two-stage rapid consensus process involving a multidisciplinary panel of clinicians, educators, and external experts in psychology and occupational health. Consensus was defined as the absence of substantial disagreement. The resulting content was mapped to competency dimensions informed by competency-based medical education principles and aligned with Miller's Pyramid, a hierarchical model of clinical competence ranging from knowledge to action.

The process resulted in a competency-based framework comprising eight educational domains: relevance of mental health, ICU-specific stressors, conceptual understanding of stress, resilience and coping, the second victim phenomenon (the psychological impact on healthcare professionals following adverse events), structural support systems, professional self-reflection, and shared responsibility. Each domain was operationalized into competency levels (knowledge to evaluation), enabling constructive alignment between learning objectives, teaching formats, and potential assessment strategies. The framework integrates individual, team, and organizational perspectives and provides a structured basis for embedding psychosocial competencies into onboarding curricula.

This study may contribute to advancing health professions education and supports constructive alignment among learning objectives, teaching formats, and assessment strategies. It operationalizes existing recommendations into actionable educational components and supports constructive alignment in curriculum design. Implementation and evaluation studies are warranted to assess its impact on learning outcomes, behavioral change, and clinical practice.