Entrustable professional activities (EPAs) for postgraduate competency based intensive care medicine training in the Netherlands: The next step towards excellence in intensive care medicine training.

INTRODUCTION: The Competency Based Training in Intensive Care Education (CoBaTrICE) programme developed common standards of ICM training by describing competencies of an intensivist. Entrustable Professional Activities (EPAs) of Intensive Care Medicine (ICM) (EPAsICM) are presented as a new workplace-based assessment tool in competency-based training of intensivists. EPAs are activities to be entrusted to a trainee once he (or she) has attained competence. EPAs emphasise the role of trust between trainees and supervisors. EPAs bridge the gap between competencies and competence. METHODS: An expert panel of ICM (vice)programme directors and intensivists in The Netherlands integrated the CoBaTrICE and CanMEDS competencies into EPAsICM. Comment and feedback was sought from other ICM programme directors and educational experts and processed in the final version of EPAsICM before implementation in the Dutch ICM training programme. RESULTS: A list of 15 EPAsICM are considered to reflect the spectrum of clinical practice while incorporating the competencies of CoBaTrICE and CanMEDS. The grading system is designed as a 5-point entrustment scale based on the amount of supervision a trainee needs, aligning with daily judgement of trainees by intensivists. CONCLUSION: EPAsICM is an assessment tool that formalises entrustment decisions and can be a valuable addition in international ICM training.

Cardiac troponin I release and cytokine response during experimental human endotoxaemia.

OBJECTIVE: To study the relationship between cytokine levels and cardiac troponin I (cTnI). DESIGN: Prospective experimental study. SETTING: Intensive care unit of a university hospital. PARTICIPANTS: Six healthy male volunteers. INTERVENTIONS. Endotoxin, 4 ng/kg, was given as a 1-min intravenous infusion. MEASUREMENTS AND RESULTS: Circulating cardiac troponin I levels and proinflammatory cytokines tumour necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and interleukin-8 (IL-8) were analysed at various time points during a 24-h period. TNF-alpha appeared in the circulation 30 min after injection (T=0.5 h), reaching peak levels (5,665+/-1,910 pg/ml) 2 h after infusion. At T=24 h TNF-alpha was still elevated in the circulation compared to T=0. None of the six volunteers had a cTnI value higher than 0.1 microg/l at T=0, 6 h or 24 h. CONCLUSION: The presence of significant amounts of TNF-alpha, IL-6 and IL-8 in the systemic circulation does not lead to increased levels of cTnI in experimental human endotoxaemia.