Curriculum analysis of the English National Board for Nursing, Midwifery, and Health Visiting (ENB) critical care programs ENB 100, 124, 176/183, 199, and 415 revealed great diversity in programs bearing the same title. An evaluation identified if this diversity was reflected in the competencies acquired by students on different programs, students' learning experiences, or preparation of clinicians for the demands of current critical care practice. Data sources at five case study sites included interviews and observation to ascertain the clinical reality in which students undertook the practice component of the course. From these data, a set of competencies for each critical care course was generated. The findings indicate different stakeholders held different views on the definition of "effective education." Examples of the values-reality gap were illuminated. For example, in practice, a gap exists between espoused values of care delivery and the reality of care provision. Within the higher education institution sector, a gap exists where the values of learning and teaching have been engulfed by the quasi purchaser-provider split. Many clinical settings needed to reexamine how they achieved an effective clinical environment beside a quality learning environment. To ensure greater parity and equivalence of program outcomes through threshold standards, the following implications were identified: disparate student population; clinical experience; and practice assessment. (YLB)