Preparing teachers for competency-based medical education: Fundamental teaching activities.

INTRODUCTION: The move to competency-based medical education has created new challenges for medical teachers, including the need to reflect on and further develop their own competencies as teachers. Guidance is needed to ensure comprehensive and coherent programs of faculty development to meet the needs of teachers. METHODS: The Working Group on Faculty Development of the College of Family Physicians of Canada developed a new concept, Fundamental Teaching Activities (FTAs), to describe the day-to-day work of teachers. These activities are intended to guide teacher professional development. Using task analysis and iterative reviews with teachers and educational leaders, these FTAs were organized into a framework for teachers to identify the actions involved in various teaching tasks, and to reflect on their teaching performance and next steps in personal development. RESULTS: In addition to use by teachers for personal development, the framework is being employed to guide the development of comprehensive faculty development offerings and curriculum, and to organize the beginnings of a national repository of teaching tools. CONCLUSIONS: Designed to support and aid teachers and those charged with faculty development, the Fundamental Teaching Activities Framework holds promise for all teachers in health sciences education.

Educational renewal of physician training in Australia and New Zealand: Multiple educational innovations in a complex environment.

AIM: The Royal Australasian College of Physicians is renewing its specialty training programs and shifting towards competency-based medical education. Our aim is to improve the quality and rigor of training and graduate outcomes, and promote high standards of physician practice to serve the health of patients, families, and communities in a changing healthcare environment. METHODS: We are progressing holistic change and multiple educational innovations in a complex environment. Numerous stakeholders, a disparate training landscape and a largely volunteer supervisor workforce pose challenges in supporting effective implementation. This paper describes our progress and experience with three key components of our education renewal program: curricular renewal, a new selection process and faculty development. It offers reflections on the practical challenges, lessons learned and factors critical for success. CONCLUSIONS: Our experience highlights opportunities for training organizations to maximize their influence over workplace training experiences and outcomes by taking a systems approach to the design, delivery and evaluation of the components of education renewal. We found that design, development and delivery of our multiple educational innovations have benefited from co-design approaches, progressive and concurrent development, continual exploration of new strategies, and implementation as soon as viable with a commitment to iterative improvements over time.

Developing a national competency-based curriculum for technical nurses in Egypt.

Nursing in Egypt has evolved over recent decades. Development has accelerated following recent government recognition of the contribution nurses make to healthcare access, quality and delivery. A vision to enhance nursing capacity resulted in a recent mandate requiring all nursing curricula to be competency based. Concurrently, the Educational Development Fund of the Egyptian Cabinet of Ministers drafted a nursing educational plan including a strategy to develop and implement a contextually congruent educational model with proven success comparable to international standards. This report discusses the 4-year curriculum development project designed to upgrade the current technical-level nursing curriculum to a consistent competency-based model. The competency-based educational model will be trialled in 3 technical institutes before nationwide rollout and implementation. Details of the project plan are described, including an overview of curriculum development considerations. This report provides insights for policy-makers and educators embarking on similar health workforce reform and capacity development initiatives.

Preparing anesthesiology faculty for competency-based medical education.

PURPOSE: Competency-based medical education (CBME) is quickly becoming the dominant organizing principle for medical residency programs. As CBME requires changes in the way medical education is delivered, faculty will need to acquire new skills in teaching and assessment in order to navigate the transition. In this paper, we examine the evidence supporting best practices in faculty development, propose strategies for faculty development for CBME-based residency programs, and discuss the results of faculty development initiatives at the pioneering anesthesia CBME residency program at the University of Ottawa. SOURCE: Review of the current literature and information from the University of Ottawa anesthesia residency program. PRINCIPAL FINDINGS: Faculty development is critical to the success of CBME programs. Attention must be paid to the competence of faculty to teach and assess all of the CanMEDS roles. At the University of Ottawa, some faculty development initiatives were very successful, while others were hindered by factors both internal and external to the residency program. Many faculty development activities had low attendance rates. CONCLUSIONS: Faculty development must be considered in the rollout of any new educational initiative. Experts suggest that faculty development for CBME should incorporate educational activities using multiple teaching and delivery methods, and should be offered longitudinally through the planning, development, and implementation phases of curriculum change. Additionally, these educational activities must continue until all faculty have demonstrated an acceptable level of competence. Faculty buy-in is paramount to the successful delivery of any faculty development program that is not mandatory in nature.

The role of blended learning in the clinical education of healthcare students: a systematic review.

BACKGROUND: Developing practice knowledge in healthcare is a complex process that is difficult to teach. Clinical education exposes students to authentic learning situations, but students also need epistemological access to tacit knowledge and clinical reasoning skills in order to interpret clinical problems. Blended learning offers opportunities for the complexity of learning by integrating face-to-face and online interaction. However, little is known about its use in clinical education. AIM: To determine the impact of blended learning in the clinical education of healthcare students. METHODS: Articles published between 2000 and 2010 were retrieved from online and print sources, and included multiple search methodologies. Search terms were derived following a preliminary review of relevant literature. RESULTS: A total of 71 articles were retrieved and 57 were removed after two rounds of analysis. Further methodological appraisals excluded another seven, leaving seven for the review. All studies reviewed evaluated the use of a blended learning intervention in a clinical context, although each intervention was different. Three studies included a control group, and two were qualitative in nature. Blended learning was shown to help bridge the gap between theory and practice and to improve a range of selected clinical competencies among students. CONCLUSION: Few high-quality studies were found to evaluate the role of blended learning in clinical education, and those that were found provide only rudimentary evidence that integrating technology-enhanced teaching with traditional approaches have potential to improve clinical competencies among health students. Further well-designed research into the use of blended learning in clinical education is therefore needed before we rush to adopt it.

Developing a skills-based competency course.

Skills-based competency programs evaluate whether participants can demonstrate knowledge, skills, and professional behaviors associated with a skill in a simulated or actual clinical setting. Critical elements for program development include accurate and precise outcome statements that delineate the skill to be performed and valid and reliable evaluation criteria that identify the critical behaviors necessary for safe and competent performance.

Toward Competency-Based Training: To What Extent Are We Competency-Based?

BACKGROUND: Time-based training models in plastic surgery vary in exposure, resulting in low confidence levels among graduates. The evolution of postgraduate medical education into a competency-based model to address these issues requires an understanding of interventions described in the plastic surgery literature to identify gaps and guide creation of assessments to demonstrate competence. METHODS: A systematic search of the MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Cochrane databases from inception until December of 2017 was conducted using search terms and synonyms of educational interventions reported in plastic surgery. Full texts were retrieved following filtering and data extracted were related to intervention design and execution, involvement of competency assessment, and educational objectives and alignment to Accreditation Council for Graduate Medical Education competencies and Royal College of Physicians and Surgeons of Canada Canadian Medical Education Directives for Specialists roles. Study quality was assessed using Kirkpatrick's levels of learning evaluation, validity evidence, and the Medical Education Research Study Quality Instrument score. RESULTS: Of the initial 4307 results, only 36 interventions met the inclusion criteria. Almost all interventions aligned to medical knowledge and patient care Accreditation Council for Graduate Medical Education competencies. One-fifth of the interventions involved no assessment of competency, whereas most displayed assessment at the level of design as opposed to outcomes. Quality assessment revealed low levels of learning evaluation and evidence of validity; the average Medical Education Research Study Quality Instrument score was 10.9 of 18. CONCLUSION: A systematic review of educational literature in plastic surgery was conducted to assess the quality of reported educational interventions, and to help guide creating tools that ensure competency acquirement among trainees.

The role of assessment in competency-based medical education.

Competency-based medical education (CBME), by definition, necessitates a robust and multifaceted assessment system. Assessment and the judgments or evaluations that arise from it are important at the level of the trainee, the program, and the public. When designing an assessment system for CBME, medical education leaders must attend to the context of the multiple settings where clinical training occurs. CBME further requires assessment processes that are more continuous and frequent, criterion-based, developmental, work-based where possible, use assessment methods and tools that meet minimum requirements for quality, use both quantitative and qualitative measures and methods, and involve the wisdom of group process in making judgments about trainee progress. Like all changes in medical education, CBME is a work in progress. Given the importance of assessment and evaluation for CBME, the medical education community will need more collaborative research to address several major challenges in assessment, including "best practices" in the context of systems and institutional culture and how to best to train faculty to be better evaluators. Finally, we must remember that expertise, not competence, is the ultimate goal. CBME does not end with graduation from a training program, but should represent a career that includes ongoing assessment.

Building a competency-based workplace curriculum around entrustable professional activities: The case of physician assistant training.

BACKGROUND AND AIM: Competency-based medical education (CBME) is increasingly dominating clinical training, but also poses questions as to its practical implementation. There is a need for practical guidelines to translate CBME to the clinical work floor. This article aims to provide a practical model, based on the concept of entrustable professional activities (EPAs) to make this translation, derived from curriculum building for physician assistants (PAs). METHOD: For the training of PAs at the Utrecht University of Applied Sciences, a three-step model was developed to guide competency-based curriculum development, teaching and assessment. It includes specific guidelines for the identification, systematic description and planning of EPAs. RESULTS: The EPA concept appeared to be a useful tool to build competency-based clinical workplace curricula. Implementation of the curriculum requires use of trainee portfolios and progress interviews, statements of rewarded responsibility and training of supervisors. The individualised approach and flexibility that true CBME implies is brought into practice with this model. DISCUSSION: The model may also be transferred to other domains of clinical training, among which postgraduate training for medical specialties.

QSEN Transcends Cultures: Teaching Quality and Safety Education in China.

There has been increasing focus on improving the quality and safety of health care globally. Understanding that the health of one nation impacts others worldwide drives initiatives for collaboration to improve the health of all. In this, the Year of the Nurse and Midwife as designated by the World Health Organization, The Quality and Safety Education for Nurses (QSEN) Competencies provide structure that transcends culture for framing the nursing role to contribute to improving patient safety and the quality of care delivery internationally. This article describes initiatives to share resources and strategies to support quality and safety education and practice with nurses across countries. [J Contin Educ Nurs. 2020;51(3):106-108.].

Development of a capability-based training programme for an advanced nurse practitioner.

Although there is a long history of advanced nursing practice in the UK, without registration it is difficult to ensure that all staff who regard themselves as advanced practitioners have the necessary clinical acumen. This article explores how a capability-based training programme was developed for one advanced nurse practitioner (ANP) in the care of older people in a community healthcare NHS trust. It also considers whether the programme could be replicated for other clinicians wishing to train for a specific advanced practice role. The programme was developed as part of a service improvement project and used work-based practice to identify the clinician's learning needs. Various learning tools were used and the trainee ANP recorded their development in a portfolio of work including reflections and clinical summaries. The main direction for learning was through the use of a written programme guide that set out benchmarks to be achieved during the two-year programme. The trainee ANP met the requirements of the programme and was appointed to a senior ANP post at the end of the two years. There is merit in using a standardised capability-based training programme when developing advanced practitioners. Standardisation allows an organisation to ensure that advanced practitioners can provide an appropriate level of clinical practice to older patients with complex needs.

Establishing Competencies for a Global Health Workforce: Recommendations from the Association of Pacific Rim Universities.

BACKGROUND: The Association of Pacific Rim Universities Global Health Program facilitates exchange of information, knowledge and experiences in global health education and research among its 50 member universities. Despite the proliferation of global health educational programs worldwide, a lack of consensus exists regarding core competencies in global health training and how these are best taught. METHODS: A workshop was convened with 30 faculty, university administrators, students, and NGO workers representing both the Global North and South to gain consensus on core competencies in masters'-level global health training. The co-authors then collaborated to refine the list of competencies, categorize them into domains, and develop a plan for how academic institutions can ensure that these competencies are effectively taught. FINDINGS: Nineteen competencies across five domains were identified: knowledge of trends and determinants of global disease patterns; cultural competency; global health governance, diplomacy and leadership; project management; and ethics and human rights. The plan for how academic institutions can best train students on these competencies outlined five key opportunities: coursework; practicums; research opportunities; mentorship; and evaluation. The plan recommended additional institutional strategies such as maximizing collaborative research opportunities, international partnerships, capacity-building grants, and use of educational technology to support these goals. CONCLUSIONS AND RECOMMENDATIONS: While further research on the implementation of competency-based training is warranted, this work offers a step forward in advancing competency-based global health masters' education as identified by a globally diverse group of expert stakeholders and economies. Given the challenges facing the current global health landscape, comparable competency-based training across institutions is critical to ensure the training of competent global health professionals.

Clinical Educator as Coach: Supporting Staff to Meet Quality and Safety Competencies.

Direct care nurses are frequently motivated to enhance practice processes but do not always understand the sequential steps that create sustainable improvement. Focusing on a local clinical problem and coaching staff through the steps for sustainable improvement as a learning activity builds competency. Framing learning activities in the Quality and Safety Education for Nurses (QSEN) competencies provides structure that supports the lifelong learning required for competent clinical practice. This article describes a creative teaching strategy clinical educators can use to enhance the knowledge, skills, and attitudes of direct care nurses for quality and safety competencies. [J Contin Educ Nurs. 2019;50(5):201-204].

Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.

PURPOSE: Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered. METHOD: In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1-5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change. RESULTS: Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93). CONCLUSIONS: While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.

A workforce in crisis: a case study to expand allied ophthalmic personnel.

OBJECTIVE: To examine how the development of allied ophthalmic personnel training programs affects human resource capacity. DESIGN: Using a qualitative case study method conducted at a single Ontario institution, this article describes 6 years of establishing a 2-tiered allied ophthalmic personnel training program. PARTICIPANTS: The Kingston Ophthalmic Training Centre participated in the study with 8 leadership and program graduate interviews. METHODS: To assess regional eye health workforce needs, a case study and iterative process used triangulations of the literature, case study, and qualitative interviews with stakeholders. This research was used to develop a model for establishing allied ophthalmic personnel training programs that would result in expanding human resource capacity. RESULTS: Current human resource capacity development and deployment is inadequate to provide the needed eye care services in Canada. A competency-based curriculum and accreditation model as the platform to develop formal academic training programs is essential. Access to quality eye care and patient services can be met by task-shifting from ophthalmologists to appropriately trained allied ophthalmic personnel. CONCLUSION: Establishing formal training programs is one important strategy to supplying a well-skilled, trained, and qualified ophthalmic workforce. This initiative meets the criteria required for quality, relevance, equity, and cost-effectiveness to meet the future demands for ophthalmic patient care.

Identifying interprofessional global health competencies for 21st-century health professionals.

BACKGROUND: At the 2008 inaugural meeting of the Consortium of Universities for Global Health (CUGH), participants discussed the rapid expansion of global health programs and the lack of standardized competencies and curricula to guide these programs. In 2013, CUGH appointed a Global Health Competency Subcommittee and charged this subcommittee with identifying broad global health core competencies applicable across disciplines. OBJECTIVES: The purpose of this paper is to describe the Subcommittee's work and proposed list of interprofessional global health competencies. METHODS: After agreeing on a definition of global health to guide the Subcommittee's work, members conducted an extensive literature review to identify existing competencies in all fields relevant to global health. Subcommittee members initially identified 82 competencies in 12 separate domains, and proposed four different competency levels. The proposed competencies and domains were discussed during multiple conference calls, and subcommittee members voted to determine the final competencies to be included in two of the four proposed competency levels (global citizen and basic operational level - program oriented). FINDINGS: The final proposed list included a total of 13 competencies across 8 domains for the Global Citizen Level and 39 competencies across 11 domains for the Basic Operational Program-Oriented Level. CONCLUSIONS: There is a need for continued debate and dialog to validate the proposed set of competencies, and a need for further research to identify best strategies for incorporating these competencies into global health educational programs. Future research should focus on implementation and evaluation of these competencies across a range of educational programs, and further delineating the competencies needed across all four proposed competency levels.

Using competency-based education in the perioperative setting.

To assure quality of orientation and meet JCAHO standards in the operating room (OR), educators and managers reviewed curriculum and educational resources. Using competency-based education in a perioperative program clearly defines expectations for the OR nurse.