The engagement chasm: Time for competency-based training in employee engagement for healthcare and beyond.

BACKGROUND: Employee disengagement in healthcare and business is currently at unexceptionally high levels worldwide. Disengagement negatively impacts productivity, profitability, efficiency (waste reduction), innovation, quality, customer satisfaction and experience, staff well-being, safety, mortality, staff attendance, and turnover. Despite its serious detrimental impacts, no dedicated competency-based training curriculum exists for engagement as a competency. OBJECTIVE: To develop a competency-based educational curriculum for an Engagement Competency. METHODS: A curricular roadmap comprising the following steps was observed 1. Identifying the desired outcomes needed of trainees. These must help fulfill all the Q12 Gallup survey engagement items. 2. Explicitly defining the required Competencies, Entrustable Professional Activities, and Milestones, 3. Selecting the educational activities, and instructional methods, 4. Selecting the tools to assess progress along the milestones, and finally, 5. Designing an evaluation system to assess the outcomes of the engagement competency program. RESULTS: We developed an Engagement Competency Framework with 7 Entrustable Professional activities "rationally and practically" arranged. These are: Envision E1, Embrace E2, Empower E3, Enlighten E4, Empathize E5, Energize E6, and Evaluate E7 (the 7Es). CONCLUSION: The unfortunate global issue of disengagement in healthcare and in the business arena may be practically tackled by introducing Engagement Competency and training. It should be compulsory for all in the "leadership role". Such training may lead to remarkable performance improvement and a happier, more prosperous, and safer world.

A Systems Thinking approach for the creation of effective competency-based medical education programs.

Successful and sustainable implementation of Competency-based Medical Education (CBME) programs is a significant and daunting challenge facing medical education worldwide. Our manuscript endorses for the first time, Systems Thinking as a concept for transforming and redesigning CBME programs employing the full 7-system elements as advocated by the Biomatrix Systems Theory. The majority of internationally recommended actions and processes for such an endeavor are highlighted, each within its system element. New innovative ideas such as having competency-structured clinical training activities as well as re-writing medical textbooks following a novel competency-based roadmap for their disease monographs etc. are also highlighted. Furthermore, the need for innovative partnerships as well as novel medical rotations that may facilitate the creation of "master clinicians" are also stressed.

Competency-structured case discussion in the morning meeting: enhancing CanMEDS integration in daily practice.

Outcome-focused, competency-based educational curricula have become the norm in residency training programs. The Canadian Medical Education Directives for Specialists (CanMEDS) framework is one example of such a curriculum. However, models for incorporating all the competencies in everyday clinical practice have been difficult to accomplish. In this manuscript, a CanMEDS, competency-structured, acute case discussion in a regular morning meeting was undertaken. All the diagnostic and therapeutic interventions were explicitly organized and discussed under their respective CanMEDS competency headings. Post exercise, the majority of residents felt that they were more competent in all the competencies and indicated their willingness to continue having similarly structured acute case discussions in the future.

Cognitive schemes and strategies in diagnostic and therapeutic decision making: a primer for trainees.

Unlike novices, expert clinicians develop refined schemes and strategies that predictably allow them to provide a better quality, prompt and less error-prone patient care input. Empowering novices with cognitive aids or mental schemes as early as possible in their clinical career may significantly improve their critical thinking, problem-solving and decision-making skills. These cognitive aids may also improve trainees' use of evidence-based medicine in addition to reducing their diagnostic errors and improving their therapeutic care inputs.

Systemic vasculitis with prolonged pyrexia, recurrent facial urticaria, skin nodules, pleural effusions and venous thrombosis: an unusual presentation of an uncommon disease.

Classically presenting with multiple or single peripheral cytopenias of variable severity, the myelodysplastic syndromes may occasionally present with bizarre manifestations that confuse the clinical picture and result in significant delays in making the correct diagnosis. We describe the case of an elderly male patient whose presentation with prolonged unexplained fever coupled with cutaneous, pulmonary and other systemic features of inflammation was finally diagnosed as having a primary myelodysplastic syndrome with associated vasculitis after a delay of 4 years.

Prolonged unconsciousness in a patient with End-stage Renal Disease.

Patients with End-stage Renal Disease being immunocompromised; are prone to a variety of infections, sometimes, rare ones, more than the general population. This fact should alert the physicians to be more vigilant and have a broader scope when considering the etiology of infections in such patients. We report the case of a 65-year-old man who had a very stormy hospital stay secondary to cerebral nocardiosis with multiple brain abscesses, prolonged unconsciousness and neurological deficits. However, the patient was treated successfully, surgically and chemotherapeutically. He was discharged home in a good condition.