Core Competencies in General Intensive Care Ultrasound (GenIUS): a Delphi Study

Intensive care ultrasound has become an integral component of modern intensive care practice. The previous ESICM Delphi consensus on core competencies in intensive care ultrasound was published in 2020. Since then, clinical practice, training standards and programs, technology, and the scope of ultrasound use in intensive care medicine have evolved substantially.

The ESICM General Intensive Care Ultrasound (GenIUS) Core Faculty therefore proposes to update the previous core competency framework through a structured international Delphi consensus process. The aim is to define which ultrasound competencies should be considered core, rather than ADVANCED, for general intensive care ultrasound practice.

The Delphi process is a well-established methodology to generate consensus on a particular topic using the "collective intelligence" of panel members. After reviewing the previous consensus, the steering committee members drafted the initial competencies and will conduct iterative Delphi rounds to generate consensus among the experts. Steering Committee (SC) members will not participate in the Delphi surveys. The study findings will be reported according to the ACCORD criteria.

The Delphi panel will comprise two participant groups: expert panelists and trainee panelists. Recruitment will aim to include at least 60 panelists overall, of whom at least 10% will be clinicians in training. The panel will be international, multidisciplinary, and balanced regarding geographical region, profession, clinical background, sex, ultrasound expertise, and level of training. Participants will be invited worldwide without country restrictions. To ensure representation of diverse healthcare and resource settings, at least 20% of panelists will be based in low- and middle-income countries (LMICs). Recruitment will also aim for broader representation across world regions. Including both experienced clinicians and clinicians in training is intended to ensure the resulting competency framework reflects the perspectives of both established experts and future users of the GenIUS curriculum.

Steps of the Delphi process

Step 1: Establishing a preliminary list of competencies. A focused literature review will be performed by the members of the SC and, based on their input, the steering committee will identify competencies, which will be used to draft Round One of the Delphi process. Prior to Round 1, the Delphi questionnaire will be pilot-tested with a small group of members from the SC.

Step 2: Preparation of the Delphi Round One Survey. The list of competencies will be sent to the Experts as a Delphi questionnaire. The anonymity of the Experts will be maintained until the end of the Delphi rounds. The Experts will be requested to answer questions related to the training curriculum based on their experience and knowledge of the subject. Questions will be based on a 5-point Likert scale (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree). Experts can also provide opinions on additions, deletions, or changes to questions or choices through free text. The responses of experts will be collated during the analysis of results and shared in the following survey as controlled feedback.

Step 3: Subsequent Delphi Rounds. The steering committee will review the results of round one. The competencies listed will be modified, deleted, or added if found ambiguous based on the feedback and comments on the results. The remaining statements will continue in subsequent rounds until response stability is achieved. The cumulative results of round two will be presented to experts along with anonymized comments, and the survey process will be repeated with the modified questionnaire. The Delphi rounds will be continued until the desired consensus and stability are achieved for statements.

Step 4: Final Consensus. Only the competencies that achieved consensus and stability will be used to develop consensus statements. The results of the final survey, consensus statements, and the manuscript will be circulated among the experts for approval before submission for publication.

Statistics Consensus definitions

• Consensus for inclusion: >=80% of panelists score the item 4-5 (strong consensus >=90% of them or median of 5 [interquartile range, IQR 0 or 1]).
• Consensus for exclusion: >80% of panelists score the item 1-2 (strong consensus >=90% of them or median of 1 [IQR 0 or 1]).
• No consensus: failure to meet either threshold after the final Delphi round or when stable non-consensus is reached.

Stability assessment Starting from Round 2, stability will be assessed between two consecutive rounds. An item will be considered stable if there is no statistically significant change in the distribution of responses between consecutive rounds. Wilcoxon signed-rank test will be used, with p ≥ 0.05 indicating significant variation and therefore instability

Statistical reporting For each competency and each round, the methodologist should report the number of respondents, response rate, median, interquartile range, percentage agreement for inclusion, percentage agreement for exclusion, consensus status, stability status, and final classification. Continuous variables will be summarized using the median and IQR. Analysis should be performed using validated statistical software such as R.