Competency based education Competency An observable ability of

Competency based education

Competency • An observable ability of a health professional, integrating multiple components such as knowledge, skills, values, and attitudes. • Since competencies are observable, they can be measured and assessed to ensure their acquisition. Frank JR, Snell LS, Ten Cate O, et al. Competency-based medical education: theory to practice. Medical Teacher. 2010; 32(8): 638 -645.

Key paper

There are (at least) 6 areas to consider A. Patients and population care B. Knowledge C. Evidence Based practice and life-long learning D. Interpersonal and communication skills E. Ethics and professionalism F. Health care system and Cost effective practice

Dreyfus & Dreyfus proposed a 5 stage model Novice Strictly adheres to rules Advanced beginner Limited situational perception Competent Proficient Expert Copes with crowdedness Plans… Decision making Holistic view, prioritizes Transcends reliance on rules Intuitive

Usually now use a 7 stage model Student Novice Advanced beginner Competent Proficient Expert Master • We should be expecting our students to be reaching advanced beginner to competent status by the time of their assessment Student Novice Advanced beginner Competent Proficient Expert Master

Link between competencies and curriculum? Is dependent on the context – which includes • The level of the student • The previous experience of the student • The discipline • The environment • And it will include a consideration of “attitudes”

The link between activities and themes Entrustable Professional Activities (EPA) EPAEPA 11 EPAEPA 22 EPAEPA 33 EPAEPA 44 EPAEPA 55 EPAEPA 66 EPAEPA 77 EPAEPA 88 EPA 9 EPA 10 EPA 11 EPA 12 Domains of Competence (Do. C) Do. C-1 Do. C-3 Do. C-2 Do. C-4 Do. C-5 Do. C-6 Do. C-7 Do. C-8 C-1: O 1, O 2, O 3, …. C-2: O 1, O 2, Curriculum Objectives (O) O 3, …. C-3: O 1, O 2, O 3, …. : Research Personal & professiona l developmen t IP Communica tion and collaboratio n Knowledg e for practice Populatio n Health Patient care & clinical skills Curriculum Themes (T) EPA 13

Example of a Domain of competency: Patient Care C 1. Communicate effectively with patients, families and groups. C 2. Gather essential and accurate information about their patients, for the purposes of problem identification and characterization. C 3. Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment. C 4. Develop and carry out (patient) management plans, with the engagement of patients considering culture, beliefs and patient’s preference. C 5. Perform competently medical procedures considered essential for the management of common health problems. C 6. Counsel and educate patients and their families. C 7. Use information technology to support patient care decisions and patient education. C 8. Provide and advocate for healthcare services aimed at preventing health problems or maintaining health. C 9. Work with healthcare professionals, including those from other disciplines and professions, to provide patient, family and community care.

Example of Curriculum Objectives (O): Derived from the Competency Domain of Patient Care O 1. Obtain an accurate holistic medical history that covers all essential aspects of a patient and his/her problem, including issues related to age, gender and socio-economic status. O 2. Reason deductively in solving clinical problems. O 3. Perform both a complete and a focused organ system specific examination, including a mental status examination. O 4. Perform routine technical procedures at a level suitable to medical students. O 5. Construct basic appropriate management strategies (both diagnostic and therapeutic) for patients with common conditions related to different age groups and genders, both acute and chronic, including medical, psychiatric, and surgical conditions, and those requiring short- and long-term rehabilitation….

Matrix/Blueprint

So, for discussion. As a clinical educator… 1. What are your beliefs about how best learning should be in the clinical environment? 2. What outcome competencies you would like the students to acquire by the end of 6 to 10 weeks of clerkship training? 3. What activities /responsibilities, delivery strategies you will implement in order to facilitate the acquisition of the identified objectives? 4. How the students will know they are progressing and on the right track? 5. How are you going to monitor the implementation of what was planned? 6. How are you going to evaluate the students "What, How, By Whom and When “?

Your responses As a clinical educator… 1. What are your beliefs about how best learning should be in the clinical environment? • … • …

Your responses As a clinical educator… 2. What outcome competencies you would like the students to acquire by the end of 6 to 10 weeks of clerkship training? • • • … … …

Your responses As a clinical educator… 3. What activities /responsibilities, delivery strategies you will implement in order to facilitate the acquisition of the identified objectives? • … • … • …