A Delphi study to create grade-specific competencies for a trust-wide non-invasive ventilation training programme

Introduction: Non-invasive ventilation (NIV) is an expanding treatment modality for respiratory failure and is increasingly used in non-specialist acute areas. Although comprehensive national guidelines exist, there is no consensus as to the expected level of competency for non-specialist health professionals. We used a modified Delphi process to create grade-specific NIV competencies which were then used to structure a comprehensive grade-based training programme. Method: A 3 round Delphi process was used with an expert panel of 20 respiratory consultants, registrars, physiotherapists and nurses. A provisional list of competencies was created following amendment by the expert panel of an initial draft formulated by literature and peer review. In the second round, competencies were added or deleted following statistical analysis of grade-based relevancy rating using a 6-point Likert scale. Competencies where consensus was not reached were resent in the third round alongside expert viewpoint. Competencies with no consensus following 3 rounds were deleted. The finalised lists were sent to a selection of each grade for self-assessment of competency. Results: A high variability was noted in competency expectation amongst our expert panel. Self-assessment showed gross lack of competency amongst junior doctors and nurses with high variability at specialist trainee level. Conclusion: Competencies were used to create a grade-based training programme with objective trainee learning outcomes. The study revealed a high level of inconsistency regarding expectation amongst NIV specialists alongside exposing the lack of current formal NIV training and weaknesses of an apprenticeship model.