Accelerated competency-based education in primary care (ACE-PC): a 3-year UC Davis and Kaiser permanente partnership to meet California's primary care physician workforce needs.

PROBLEM: Our nation faces an urgent need for more primary care (PC) physicians, yet interest in PC careers is dwindling. Students from underrepresented in medicine (UIM) backgrounds are more likely to choose PC and practice in underserved areas yet their representation has declined. Accelerated PC programs have the potential to address workforce needs, lower educational debt, and diversify the physician workforce to advance health equity. APPROACH: With support from Kaiser Permanente Northern California (KPNC) and the American Medical Association's Accelerating Change in Medical Education initiative, University of California School of Medicine (UC Davis) implemented the Accelerated Competency-based Education in Primary Care (ACE-PC) program - a six-year pathway from medical school to residency for students committed to health equity and careers in family medicine or PC-internal medicine. ACE-PC accepts 6-10 students per year using the same holistic admissions process as the 4-year MD program with an additional panel interview that includes affiliated residency program faculty from UC Davis and KPNC. The undergraduate curriculum features: PC continuity clinic with a single preceptor throughout medical school; a 9-month longitudinal integrated clerkship; supportive PC faculty and culture; markedly reduced student debt with full-tuition scholarships; weekly PC didactics; and clinical rotations in affiliated residency programs with the opportunity to match into specific ACE-PC residency tracks. OUTCOMES: Since 2014, 70 students have matriculated to ACE-PC, 71% from UIM groups, 64% are first-generation college students. Of the graduates, 48% have entered residency in family medicine and 52% in PC-internal medicine. In 2020, the first graduates entered the PC workforce; all are practicing in California, including 66% at federally qualified health centers, key providers of underserved care.

AACN competency-based essentials revisit: Evidence-based validation of entrustable professional activities in Asia.

AIM: This study intended to validate the competency-based approach through an entrustable professional activity in the nursing undergraduate education arena in Taiwan. BACKGROUND: Entrustable professional activity is a recommended strategy to enhance nursing competencies and skills. It has been widely applied to nursing education in Western countries, especially graduate programs. However, its effects in eastern countries and undergraduate programs remain unclear. DESIGN: A quasi-experimental comparison design was used. METHOD: The study is conducted at the Department of Nursing at a university in southern Taiwan. A total of 72 Two-Year Nursing Program students participated in the study. After implementing the designated entrustable professional activity in the Wound Care Nursing course, outcomes were measured using the Competency Inventory of Nursing Students, Learning Satisfaction and Objective Structured Clinical Examinations. These outcomes were then compared with post-test results at the end of the semester. About 90 % of students completed the study with the test group (n=31) receiving extra activity and the comparison group (n=34) receiving usual teaching. Data were analyzed through chi-square, paired t and Student's t-test. RESULTS: The test group demonstrated significantly higher scores in perceived competency and clinical examinations than the comparison group. However, both groups experienced an increase in learning satisfaction without reaching a significant difference. CONCLUSION: Results of the study indicate that competency-based pedagogy, e.g., using entrustable professional activities, should be integrated into nursing curricula to meet the new American Association of Colleges of Nursing standards with compelling evidence.

Evaluation of the BOPPPS model on otolaryngologic education for five-year undergraduates.

BACKGROUND: This study aimed to assess the effectiveness of the BOPPPS model (bridge-in, learning objective, pre-test, participatory learning, post-test, and summary) in otolaryngology education for five-year undergraduate students. METHODS: A non-randomized controlled trial was conducted with 167 five-year undergraduate students from Anhui Medical University, who were allocated to an experimental group and a control group. The experimental group received instruction using the BOPPPS model, while the control group underwent traditional teaching methods. The evaluation of the teaching effectiveness was performed through an anonymous questionnaire based on the course evaluation questionnaire. Students' perspectives and self-evaluations were quantified using a five-point Likert scale. Furthermore, students' comprehension of the course content was measured through a comprehensive final examination at the end of the semester. RESULTS: Students in the experimental group reported significantly higher scores in various competencies compared to the control group: planning work (4.27 ± 0.676 vs. 4.03 ± 0.581, P < 0.05), problem-solving skills (4.31 ± 0.624 vs. 4.03 ± 0.559, P < 0.01), teamwork abilities (4.19 ± 0.704 vs. 3.87 ± 0.758, P < 0.05), and analytical skills (4.31 ± 0.719 vs. 4.05 ± 0.622, P < 0.05). They also reported higher motivation for learning (4.48 ± 0.618 vs. 4.09 ± 0.582, P < 0.01). Additionally, students in the experimental group felt more confident tackling unfamiliar problems (4.21 ± 0.743 vs. 3.95 ± 0.636, P < 0.05), had a clearer understanding of teachers' expectations (4.31 ± 0.552 vs. 4.08 ± 0.555, P < 0.05), and perceived more effort from teachers to understand their difficulties (4.42 ± 0.577 vs. 4.13 ± 0.59, P < 0.01). They emphasized comprehension over memorization (3.65 ± 1.176 vs. 3.18 ± 1.065, P < 0.05) and received more helpful feedback (4.40 ± 0.574 vs. 4.08 ± 0.585, P < 0.01). Lecturers were rated better at explaining concepts (4.42 ± 0.539 vs. 4.08 ± 0.619, P < 0.01) and making subjects interesting (4.50 ± 0.546 vs. 4.08 ± 0.632, P < 0.01). Overall, the experimental group expressed higher course satisfaction (4.56 ± 0.542 vs. 4.34 ± 0.641, P < 0.05). In terms of examination performance, the experimental group scored higher on the final examination (87.7 ± 6.7 vs. 84.0 ± 7.7, P < 0.01) and in noun-interpretation (27.0 ± 1.6 vs. 26.1 ± 2.4, P < 0.01). CONCLUSION: The BOPPPS model emerged as an effective and innovative teaching method, particularly in enhancing students' competencies in otolaryngology education. Based on the findings of this study, educators and institutions were encouraged to consider incorporating the BOPPPS model into their curricula to enhance the learning experiences and outcomes of students.

Re-thinking the Concept of Cultural Competency in Nursing Care of Older Adults.

The influx of migrants to Canada has resulted in a shift in the country's demographic landscape. Individuals often interpret and approach health and wellness through the lens of their cultural heritage, which has led to stereotyping behaviors and discriminatory practices, exacerbating the notion of "Othering". Immigrant older adults are likely to experience discrimination in a more dreadful way in the form of societal isolation and marginalization due to the collective systems of power such as ageism, ableism, and racism. This paper results from continuous thought-provoking discussions initiated by the first author (AM) in her doctoral program at the University of Western Ontario for the Philosophy of Nursing Science course, taught and facilitated by the second author (SM). After studying the course materials on "revolutionary science" and reflection on the process of paradigm shift introduced by Thomas Khun and engaging in critical discussions on a range of relevant philosophical concepts such as bio-power, othering, silencing and ignorance, marginalization, oppression, neoliberalism, health equity, and social justice, we have been prompted to rethink the concept of cultural competence in nursing education and healthcare practices, particularly in the context of nursing care of older adults. Therefore, in this paper, we will critique the concept of cultural competency in the context of an anti-racist and anti-oppressive lens and suggest a pivotal response to move towards an inquiry-driven approach based on cultural humility and respect in the nursing care of older adults.

Enhancing the Central Venous Catheterization Competency of Medical Students through a Specialized Team and an Interactive Response System: A pre-post study.

Background: Central venous catheterization (CVC) is a critical clinical procedure. To avoid complications, possessing good knowledge regarding the CVC care bundle and skills for the proper insertion and maintenance of CVC are important. Objectives: To evaluate the effectiveness of an educational intervention and the use of an interactive response system in enhancing the CVC bundle care and insertion skills of medical students undergoing critical care medicine training. Materials and Methods: Sixth-year medical students (equivalent to fourth-year students in the United States) engaged in didactic lessons, interactive demonstrations, and simulator training facilitated by a CVC team comprising three thoracic and two vascular surgeons (all with a minimum 5 years of experience in central venous access) during their intensive care unit (ICU) rotation. Self-reported knowledge and confidence levels were assessed using pre-and posttests administered through the Zuvio App, an interactive response system. Results: A total of 60 students underwent the educational intervention, of which 54 completed the pretest and 40 completed the posttest. In the posttest, significant improvement was found in the CVC bundle care competency and understanding (P = 0.002), preprocedural preparation (P = 0.002), insertion procedures (P = 0.004), complications (P = 0.003), and insertion depth decisions (P = 0.001). Staff and students reported that assessment and interaction via the Zuvio App were valuable, practical, and feasible in a clinical setting, providing trainees with an individual competency portfolio of receiving precise medical education. Conclusions: Integrating the training provided by a specialized team with an interactive response system enhanced the knowledge and competency level in CVC insertion among medical students in this study.

Construction and validation of an Entrepreneurship Measurement Instrument for nursing students.

Objective: To develop a valid and reliable scale to measure entrepreneurship competences of nursing students, by assessing the level of development of diverse entrepreneurship dimensions. Methods: An Entrepreneurship Measurement Instrument, Catalonia (IME.Cat) was constructed, by adapting two existing instruments, and a psychometric study was performed to address the validity of the content and the construct, and the reliability. The internal consistency and the discrimination capacity of the instrument's items were examined. Results: The IME.Cat scale showed a high reliability (α=0.89) for the complete set of items. The Cronbach's α value of the individual dimensions were: Problem management=0.78; Creativity=0.76; Personal confidence =0.64; and Risk acceptance =0.46. The corrected homogeneity indices for each of the item in the instrument were high (>0.40). The Confirmatory Factorial Analysis validated the proposed structure of the items according to dimension. Conclusion: The IME.Cat scale showed solid psychometric values for assessing the entrepreneurship competences of nursing students within its dimensions, which are fundamental for the professional development of nursing.

Integrating innovation and competency-based education in the development of a new direct-entry master of science in nursing program.

There has been a call for nursing programs to shift to Competency-based education (CBE). Competency-based education has numerous benefits in nursing education. A curriculum that includes both concepts and competencies helps students and stakeholders understand what new nurse graduates will be able to do with the knowledge they construct throughout the program. Competency-based education is student-centered, flexible, and dependent on students actively engaging in their learning. A small faculty team developed a new direct-entry MSN program, based on essential components of CBE. This article describes the process of incorporating CBE into the development of the program, as well as challenges and barriers to fully implementing CBE into the curriculum.

Reject the "Practice Readiness Myth": Ask if systems are ready for nursing graduates instead.

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of "competency-based education" with nursing "competence" or "practice readiness." Our aim is to discuss the potential harms of conflating "competency-based education" with "competence" or "practice readiness." This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not "competent" or "ready to practice," and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about "competency-based education" and "practice readiness"; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

Utilizing Competency-Based Education to Evaluate the Research Skills of Nursing Students: A Systematic Review and Meta-Analysis.

Exploring and implementing competency-based education approaches to assess research skills are necessary to close the gap between research and practice, promote lifelong learning among future nurses, and improve research literacy. This study aims to assess the effectiveness of competency-based education in improving the assessment of research skills among nursing students. A systematic review and meta-analysis of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Population, Intervention, Comparison, Outcomes and Study (PICOS) eligibility criteria were used to select original studies published between 2017 and 2023. As a first step in the data-handling process, titles and abstracts of all articles retrieved by the search strategy were screened for relevance, and the irrelevant articles were discarded. The screening process was conducted by two authors independently, and the final decisions were made together. A meta-analysis was performed to assess the effectiveness of competency-based education in improving the assessment of research skills among nursing students. Five quantitative studies were appraised using the Joanna Briggs Institute checklist. The effect size was 0.69 ± 0.35 (P = 0.05), which indicates a high effect on research competency among nursing students who attend courses or training in research matters, after transforming data to correlation coefficient resulting in r = 0.5. The study encourages research literacy among nursing students. Through competency-based learning, students are exposed to a variety of research methodologies, ethical issues, and scientific writing conventions. This exposure enhances their capacity to understand, assess, and apply research evidence, empowering them to become knowledgeable consumers and field contributors. While making evidence-based decisions, nurses with research competencies can actively incorporate the most recent research findings into their clinical practice. Furthermore, nurses with strong research abilities can influence health policy and practice.

General nurse competencies in disaster: A delphi study.

AIM: The aim of this study is to understand the significance of a disaster-related competence framework for Portuguese general nurses and identify from ICN - Core Competencies in Disaster Nursing version 2.0 core competencies description, those that are considered crucial for a competent preparedness and response in disaster scenarios. BACKGROUND: Research suggests that the occurrence of disasters will be more recurrent, requiring that nurses, pillars of any health system, have knowledge, skills and preparedness to face these events. DESIGN: An exploratory, cross-sectional qualitative study was carried out. Delphi method was used for data collection. METHODS: The study group consisted of technical-scientific council's presidents or coordinators/directors of nursing courses, nurses integrated in the Portuguese Council of Nurses and National Nursing Specialty Colleges and nurses with experience in the field of disasters. RESULTS: Findings revealed that there is consensus on sixteen competencies, considered relevant for developing general nurse knowledge and competence, both at a national or international level, in the field of disasters. CONCLUSIONS: The development of these competencies which establishes practice standards, building nurses skills and knowledge and ultimately, influencing nursing level-entry curricula's, conferring professional autonomy and self-regulation, in the field of disaster are fundamental. Furthermore, this study may serve as a reference for future alignment of competency frameworks between European Union countries or others.

Overcoming Barriers to Research Competency: a nationwide mixed-method study on residency training in the field of Korean medicine.

Objectives: This study aimed to analyze the educational needs of interns and residents in Korean medicine as the first step in developing an education program to improve their research competencies. Methods: A mixed-method design, incorporating both quantitative and qualitative data collection methods, was used to investigate the educational needs for research competencies among interns and residents working in Korean medicine hospitals nationwide. Data were collected through online surveys and online focus group discussions (FGDs), and processed using descriptive statistical analysis and thematic analysis. The study results were derived by integrating survey data and FGD outcomes. Results: In total, 209 interns and residents participated in the survey, and 11 individuals participated in two rounds of FGDs. The majority of participants felt a lack of systematic education in research and academic writing in postgraduate medical education and highlighted the need for nationally accessible education due to significant disparities in the educational environment across hospitals and specialties. The primary barrier to learning research and academic writing identified by learners was the lack of knowledge, leading to time constraints. Improving learners' research competencies, relationship building, autonomy, and motivation through a support system was deemed crucial. The study also identified diverse learner types and preferred educational topics, indicating a demand for learner-centered education and coaching. Conclusion: This study provides foundational data for designing and developing a program on education on research competencies for interns and residents in Korean medicine and suggests the need for initiatives to strengthen these competencies.

Reliability of the Mental Health Nurse Competency Assessment Tool (ECOEnfSM): A pilot study.

AIM: To evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice. METHOD: A pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient). RESULTS: The Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (P < .01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (P < .01). All UCs showed a good to excellent consistency (r > 0.80). The "Home Visits" assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it. CONCLUSION: The ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

Changing the Clock in Medical Education: Addressing Physician Shortages and Patient Outcomes.

Despite the shortage of physicians in the United States, there is no consensus among medical educators as to how to address the nation's unmet needs. A growing but unfulfilled argument is to revisit the configuration of medical education and the time required to complete medical training. Pilot programs, such as shortened programs or advancement-in-place structures to accelerate the practice capability of trainees, have been attempted. This manuscript addresses underlying economic and human considerations that medical educators must reconcile, drawing on lessons from international educational structures, as we advance toward a system that supports the needs of the communities that our graduates will serve.

A Pharmacist Clinician Model as part of a collaborative clinical workforce: A philosophical critique.

The term 'clinician' is not reserved for any healthcare professional group. However, there is a general acceptance that a clinician would have the knowledge, skills and behaviours to enable them to clinically assess and manage a patient autonomously. The expectation, in a modern collaborative healthcare system, is that this work would be completed as a part of a planned and integrated multi-disciplinary care delivery structure, where any given clinician delivers a devolved element of that patient's care. Forthcoming changes to regulation and professional development pathways in the UK will have a profound impact on pharmacist professional identity and practice. From 2026, all new UK pharmacist registrants will have full independent prescribing rights. A paradigm shift is expected to enable the development of a Pharmacist Clinician Model, incorporating pharmaceutical care needs with wider clinical assessment, diagnostic, and clinical management responsibilities. Consideration is given to this model and its implications. Changes to regulation, policy, education, and the governance required to deliver safe and effective pharmacist clinicians are outlined. A philosophical critique on the nature of being a clinician, and the differentiation of pharmacist clinician roles compared to other healthcare professions, is given. A further examination of the projected risks and expected benefits of this transformative practice model are then explored.

Evaluating the Need for Competency-Based Pharmacy Education (CBPE): The Report of the 2023-2024 Academic Affairs Standing Committee.

The 2023-2024 Academic Affairs Committee was charged to create a sense of urgency around the concept of Competency-Based Pharmacy Education and develop a "readiness for change" instrument that is based on the 5 essential elements that make up the definition of Competency-Based Pharmacy Education. This report describes the process undertaken by the committee to determine the societal needs of pharmacists and current state of pharmacy practice and pharmacy education. The practice gaps in pharmacy education and the key drivers needed to close these gaps are evaluated. To complete the charges, the committee conducted evidence-based literature reviews and completed a series of focus groups with stakeholders and thought leaders with experience in competency-based education.

Challenges and opportunities for competency-based health professional education in Bangladesh: an interview, observation and mapping study.

BACKGROUND: Bangladesh has a shortfall of health professionals. The World Health Organization states that improving education will increase recruitment and retention of health workers. Traditional learning approaches, in medical education particularly, focus on didactic teaching, teaching of subjects and knowledge testing. These approaches have been superseded in some programmes, with a greater focus on active learning, integrated teaching and learning of knowledge, application, skills and attitudes or values and associated testing of competencies as educational outcomes. In addition, some regions do not have continuous professional development or clinical placements for health worker students, contributing to difficulties in retention of health workers. This study aims to explore the experiences of health professional education in Bangladesh, focusing on what is through observation of health professional education sessions and experiences of educators. METHODS: This mixed method study included 22 observations of teaching sessions in clinical and educational settings, detailed analysis of 8 national curricula documents mapped to Global Competency and Outcomes Framework for Universal Health Coverage and 15 interviews of professionals responsible for health education. An observational checklist was created based on previous literature which assessed training of within dimensions of basic clinical skills; diagnosis and management; professionalism; professional development; and effective communication. Interviews explored current practices within health education in Bangladesh, as well as barriers and facilitators to incorporating different approaches to learning. RESULTS: Observations revealed a variety of approaches and frameworks followed across institutions. Only one observation included all sub-competencies of the checklist. National curricula documents varied in their coverage of the Global Competency and Outcomes Framework domains. Three key themes were generated from a thematic analysis of interview transcripts: (1) education across the career span; (2) challenges for health professional education; (3) contextual factors and health professional education. Opportunities for progression and development post qualification are limited and certain professions are favoured over others. CONCLUSION: Traditional approaches seem to predominate but there is some enthusiasm for a more clinical focus to education and for more competency based approaches to teaching, learning and assessment.