The variations in structures, speciality ownership, duration, and processes of training which characterise ICM training present a challenge in terms of assessment of competence, because of the need to accommodate local variation while ensuring common outcomes - training to a standard of safe independent specialist practice. In addition, the nature of intensive care practice in some countries means that different ICUs offer varied opportunities for the acquisition and assessment of competencies. The international context of the CoBaTrICE project therefore demands a flexible approach to the assessment of competence, allowing details of the assessment process to be established at national level. With this in mind, the CoBaTrICE collaboration has produced a guide, not a proscriptive pathway, to assessing competence.

Purposes of the CoBaTrICE assessment methodology:

• To provide feedback on progress and encourage learning
• To provide evidence of the achievement of competence
• To identify the trainee in difficulty

Assessment is an educational and diagnostic activity, concerned with the identification of strengths and weaknesses. The assessment methodology is not designed to rank the performance of doctors. Rather, it is about demonstrating achievement (across a range of assessments) and identifying where more practice or support is needed.

The majority of assessments will be work-placed based, focused on what trainees do in their normal course of work. Continuing assessment will be formative in nature, providing feedback on progress, and identifying problems at an early stage to allow corrective action. Education and training 'portfolios' allow evidence to be collated which can then inform judgements about progression and contribute towards a summative decision about whether the trainee is safe for independent practice¹.

While the majority of trainees will make satisfactory progress, a few will have difficulty. It is essential for patient safety and for the trainee's career that problems are identified and managed as early as possible. Trainees shown to be in difficulty will require closer supervision and further assessment. The detail of the remedial action plan will need to be determined locally.

Components of the CoBaTrICE assessment guidelines:

• Guides to learning agreements and supervision
• Features of competent performance identified for each domain to guide assessment during routine clinical practice
• Identification of opportunities for assessment during routine clinical practice
• An assessment toolbox describing a range of work-place based assessment methods which may be adopted at a national level in order to standardise the assessment of ICM trainees.
• CoBaFolio: a portfolio template for documenting training activities and acquisition of competence
• Guide to identifying and managing trainees in difficulty
• Frequently asked questions about assessment of competence