There are many opportunities for assessment in everyday clinical practice. There are many different assessment strategies and ways to gain evidence of competence, but observation of workplace performance is a key pillar in the assessment of ICM competencies. The purpose of this section is to demonstrate how common clinical scenarios may be regarded as opportunities for work-place based observation and that these provide an accessible way to assess multiple competencies over a period of time. The examples given below are for demonstration and discussion; they should not be regarded as a prescriptive/exhaustive list.

Clinical scenarios may comprise:

A single event / task:

• patient handover
• initiating ventilation
• admitting a patient to ICU
• talking with relatives

An event / task and a patient context:

• admission and first 6 hours of care of a planned post-operative patient
• admission and first 6 hours of care of a patient with a community acquired pneumonia
• admission and first 6 hours of care of a trauma patient.

Different ICUs will offer different opportunities for assessment - these should be discussed between trainer and trainee when a learning agreement is established and reviewed. It is not likely that it will be possible to acquire and assess all competencies within a single ICU or hospital. Pre-planning and an awareness of the opportunities available during everyday clinical practice within a specific ICU are therefore important.

Common encounters between trainer and trainee:

Not all circumstances can be anticipated and planned, but examples of common encounters between a trainer and trainee which provide opportunities for observation and assessment include:

• Emergency tracheal intubation in the ICU
• Resuscitation
• Transporting a sedated, ventilated patient from ICU to the CT scanner and return.
• Attending a ward round with the microbiology team requiring the communication, processing and recording of information and the prescribing of drugs (antimicrobials etc).
• The assessment and initial management of a critically ill patient on a medical/surgical ward
• Management of the septic patient
• Handover of a group of patients

Such encounters provide an opportunity for the assessment of specific knowledge and skills, but they will also allow the trainer to observe aspects of professionalism, attitudes and behaviours, which manifest under normal working conditions.