Competency-Based Medical Education: Considering Its Past, Present, and a Post-COVID-19 Era.

Advancement toward competency-based medical education (CBME) has been hindered by inertia and a myriad of implementation challenges, including those associated with assessment of competency, accreditation/regulation, and logistical considerations. The COVID-19 pandemic disrupted medical education at every level. Time-in-training sometimes was shortened or significantly altered and there were reductions in the number and variety of clinical exposures. These and other unanticipated changes to existing models highlighted the need to advance the core principles of CBME. This manuscript describes the impact of COVID-19 on the ongoing transition to CBME, including the effects on training, curricular, and assessment processes for medical school and graduate medical education programs. The authors outline consequences of the COVID-19 disruption on learner training and assessment of competency, such as conversion to virtual learning modalities in medical school, redeployment of residents within health systems, and early graduation of trainees based on achievement of competency. Finally, the authors reflect on what the COVID-19 pandemic taught them about realization of CBME as the medical education community looks forward to a postpandemic future.

Evaluation of curricular relevance and actual integration of sex/gender and cultural competencies by final year medical students: effects of student diversity subgroups and curriculum.

Background: Diversity issues play a key role in medical practice and have recently been more explicitly integrated into undergraduate medical curricula in Europe and worldwide. However, research on students´ perspectives on the relevance and curricular integration of diversity issues, such as sex/gender and culture-sensitive competencies, is still limited. Methods: The Charité Berlin (Germany) ran in parallel a traditional and a competency-based medical program. Diversity perspectives, especially sex and gender aspects, were systematically integrated into the new curriculum. In 2016, an online questionnaire was sent to all medical students in their final clerkship year of both programs. Students provided diversity-related information (sex/gender, age, number of children, migration background or disability) and rated the relevance of sex/gender and culture-sensitive competencies and the integration into their study program. They also rated their preparedness for the final year clerkships and for working as a physician. Results: The included 184 students considered sex/gender and culture-sensitive competencies to be very relevant or relevant (62%; 73%). The ratings of the relevance are independent of the curriculum and significantly higher in female students. Regarding curricular integration, 69% of the students of the traditional curriculum evaluated the degree of implementation as minor, whereas 83% students of the new curriculum rated the degree of implementation as extensive. Degrees of preparedness for the workplace were significantly higher in students from the new curriculum, with no significant effects by sex/gender. Age group, having a child, migration background or a disability had separate effects on the students' ratings. Conclusions: Medical students in their final clerkship year rated sex/gender and culture-sensitive competencies as relevant; this was independent from their study program. Their ratings provide complementary evidence that our systematic approach to implementation resulted in a successful curricular integration.

[Medical Psychology and Medical Sociology in Transition - Review and Perspectives of the two Disciplines in Germany]. / Medizinische Psychologie und Medizinische Soziologie im Wandel ­ Bestandsaufnahme und Perspektiven der beiden Fächer in Deutschland.

AIM OF THE STUDY: Through the Master Plan for Medical Studies 2020 and the development of the National Competence-Based Learning Target Catalogue Medicine (NKLM), significant changes in university medicine were started. The aim of the study was a systematic analysis of the state and perspectives of the disciplines of medical psychology and sociology at the medical faculties in Germany. METHODOLOGY: An online survey was conducted on 5 topics (structure, teaching, research, care, perspectives). 46 departments and institutes of medical psychology and sociology were invited to the survey. RESULTS: 40 of the 46 contacted institutions have called up the online questionnaire, 35 have answered in full (return: 76.1%). 77% of the institutions are autonomous. In the median, the institutions have 15 employees (range: 1 to 149). 9 universities have established a model curriculum. More than half of the institutions use and train simulation patients. The main research priorities are clinical research, health care research, neuroscience and classical medical psychology or sociological research topics. The institutions receive primarily public funding and publish 19 publications (80% international, median) each year. Publication opportunities are considered "satisfactory" by 54% of institutions (2003: 44%), and by 29% as "very satisfactory" (2003: 21%). 9 out of 27 medical psychology institutes provide clinical services to patients and relatives with mental or chronic physical illness. Almost half of the institutions expect the Master Plan 2020 to further increase the relevance of the subjects. DISCUSSION: Since 2003 there has been a substantial increase in scientific staff, third-party funding and publications. The sites show a pronounced heterogeneity in terms of size and equipment, which leads to an imbalance in terms of teaching and research as well as clinical services. CONCLUSION: The subjects of medical psychology and medical sociology have developed very heterogeneously in terms of independence, size, equipment and possibilities at the various faculties in Germany. Therefore, it is very important in the future that the 2 disciplines intensify the dialogue with each other and also with other psychosocial disciplines in order to influence the current development regarding NKLM and Master Plan 2020 constructively. On the one hand, this calls for an expansion of disadvantaged institutions and a consolidation of the existing autonomous institutions.

School psychology training within a competency framework: Transcending the past, present, and future.

In this special issue, Conoley et al. (2020) repeat the call for a paradigm shift in school psychology graduate education from the individual level to the system level and from secondary and tertiary intervention to primary prevention and implementation science to optimize environments for children's overall health and success. This article describes how school psychology training, as organized by professional standards of practice and credentialing, has evolved to its current status as a recognized specialty of practice within psychology. A review of the history of the accreditation and approval of school psychology programs, as well as the current status of competencies within these standards and procedures are presented. In addition, school psychology as a distinct specialty; various certifications, credentials, and licensure; professional identities; and recent developments in technology, telehealth, and cross-state credentialing are examined. The article includes a summary of how competencies are reflected in the most recent revisions of American Psychological Association accreditation, National Association of School Psychologists approval standards, and credentialing organizations such as Association of State and Provincial Psychology Boards. Finally, we conclude with the assertion that development and adoption of these standards, competencies and professional recognition certifications, which are informed by the current zeitgeist in both health and education more broadly, might propel school psychology to fulfill the promise not yet achieved as outlined by Conoley and colleagues (2020). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Retrospect and prospect regarding school psychology scholarship: Reflections of Lightner Witmer award winners.

This article provides reflections on several key elements important for establishing and sustaining successful research trajectories and scholarship within the field. Developed by several Lightner Witmer Award recipients, the article highlights several of Lightner Witmer's experiences and pioneering contributions, including the importance of his own mentors, collaborations with interdisciplinary professionals, and his emphasis on the relevance of scientific research programs and the practical implications for helping children. In an effort to move the field forward, we discuss important elements relevant to developing and sustaining successful research programs in school psychology including the importance of mentorship, collaboration, research methodologies, replicability, extramural funding, and dissemination. Throughout, we emphasize the importance of conducting research within the school context, which is consistent with the important influence of ecological systems articulated by Conoley, Powers, and Gutkin (2020), and reflects the hallmark of school psychology scholarship as an applied science. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Past, present, and future of research in school psychology: The biopsychosocial ecological model as an overarching framework.

Conoley, Powers, and Gutkin (2020) called for an increased emphasis on models of psychological service delivery that are primarily indirect, adult-focused, and geared toward systems-level change in the schools. They asserted that research in school psychology should not focus on the problems of individual children and youth but address the "powerful ecosystems" that surround them. Although school- and system-wide interventions are certainly important and can have a positive impact on student outcomes, we contend that biopsychosocial models of human development that integrate the effects of genetics, personal characteristics and behaviors, environments, and broad social contexts are better frameworks for guiding future research in school psychology. In these models, the role of genetics is mediated by the family environment and broader social contexts to influence variability in cognitive, social-emotional, and behavioral domains of psychological functioning. These individual differences then interact with specific situations, leading to outcomes in educationally relevant behaviors, such as achievement, self-esteem, motivation, and peer relations. The focus of research in school psychology, therefore, should not be on "1 size fits all" school-wide interventions but rather on understanding how and why children and youth differ from one another and on translating research on the effects of genes, the environment, and their interplay into effective educational interventions. Research on bullying and victimization in schools is discussed as an example of the importance of taking a biopsychosocial ecological approach to studying complex behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

From traditional practice to tiered comprehensive services for all: Developing a responsive school culture for the future.

In this article, we reflect on the evolution of school psychology practice from the past to the present, and share some thoughts about the future. Although school psychology programs provide training in consultation, prevention, social emotional development, counseling, and mental health interventions, school psychology practice is still dominated by assessment, and the specialty has yet to live up to its promise to address the multiple needs of an increasingly diverse student population. Today's practitioners need to be skilled in systems-level programing that is informed by cultural awareness, knowledge, and skills necessary to responsibly work toward the best outcomes for students and families from all cultural, ethnic, and racial backgrounds. As the demand for mental health and other services in schools continues to increase, we argue for a wholescale adoption of culturally adapted evidence-based practices to address the expanding role of school-based practice. Finally, we offer considerations from the social psychology literature that will help school psychologists prioritize behavioral health while also reducing disparities in educational attainment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Infusing global and intercultural perspectives to transform school psychology and school psychologists.

School psychology has been criticized for limited attention to and limited evidence-based resources for diverse populations in domestic and international settings, in part because of its foundations on psychological knowledge generated primarily in North America and Western Europe. Moreover, in the past 25 years, the profession has made insufficient progress in changing its focus toward an ecological systems perspective as initially envisioned by Conoley and Gutkin in 1995 and revisited in this issue. In this article, we embrace and expand that vision to include the infusion of global and intercultural perspectives into school psychology research, training, practice, policy, and advocacy as a means to address cultural diversity within local contexts across the globe, with a particular focus on school psychology within the United States. We begin with a discussion of terminology that addresses international and cross-cultural issues related to diversity. We then examine past and present perspectives and approaches to cultural diversity and globalization within school psychology and propose future directions for research, training, practice, policy, and advocacy within a global-intercultural perspective. We conclude with our reflections about transforming school psychology and school psychologists. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Progress will come in the balancing of needs: Professional desires, consumer demand, and why we have to specialize.

Conoley, Powers, and Gutkin (2020) have provided an assessment of the progress and lack thereof of school psychology as a profession toward school reformation, especially as related to their various earlier calls for changes in training and practice. Conoley and Gutkin especially (and I have been colleagues of both) have called for decades for an emphasis on working with teachers, other adults in the school system, and the school system itself to alter the delivery of education. In some earlier work, they have characterized this as adult school psychology. In many ways this is a reconceptualization of earlier mental health consultation models of school psychology practice that were not widely adopted for reasons Conoley et al. (2020) explain. School psychology has a long history of wanting to be seen and to practice differently from in a primary role of test and place, and indeed I would characterize the primary organizations that represent the profession (the National Association of Psychologists and the American Psychological Association's Division of School Psychology) as being in many ways antagonistic toward psychological testing. Yet, it is what most school psychologists are in fact hired to do as their primary role, and training in psychological testing and assessment is one of the key skills that sets us apart and distinguishes us from others in the schools. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Considerations for school psychology to realize its promise: Commentary on the special issue from early career school psychologists.

As early career scholars, we have benefitted from the recommendations made by Conoley and Gutkin nearly 25 years ago. Our training and applied experiences were closely aligned with Conoley and Gutkin's view of school psychology practice. Namely, the content of our courses and our practice of psychology in practicum and internship were reflective of an applied ecological orientation within a prevention framework rather than focused solely on individual level services. As we reflected on the articles in the special issue, and the state of the field moving forward, we identified 2 broad recommendations we believe are integral to realizing the promise of school psychology, the applied use of an implementation science lens and the explicit centering of equity and social justice in school psychology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Can research contribute to improve educational practice?

Teaching a diverse classroom is a challenging task. Educators are faced daily with the difficult task of making many decisions about how to educate each of their students. To do this, they mainly rely on their experience and that of their colleagues, their values, and thoughts. Although they are inherent and important in the profession of teaching, sometimes these resources may not suffice to make the best decisions, particularly when teachers are continuously bombarded with numerous fads and poorly grounded ideas about education. In this context, research-informed practice emerges as a promising approach. It involves integrating the professional expertise of teachers with the best evidence of researchers to make better decisions and improve education. However, for this approach to be successfully implemented, the gap between researchers and practitioners must first be bridged. The possible solutions to this challenge involve acting in three contexts: research production, research communication and research use. Specific measures in each of these contexts are described

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Competency-based education in transitioning nurse practitioner students from education into practice.

Competency-based education (CBE) provides a framework for nursing programs including those educating nurse practitioners (NPs). The basic assumption of CBE is that the student will demonstrate acquisition of the identified essential knowledge, skills, and attitudes expected for the designated educational process before leaving the learning environment. The work done to date in developing competencies and progression indicators provides the critical basis to move toward a common language and clear expectations for the continuum of linear progression of proficiency. Entrustable professional activities (EPAs) are built on competencies and stated as measurable activities that providers can be expected to do, at varying levels of competence or trust or supervision, and allow the faculty member, preceptor, or supervisor to make decisions as to what teaching methods and level of supervision are needed. Numerous methods are used to measure competency in clinical skill knowledge, performance, and practice readiness including clinical preceptor feedback, objective structured clinical examination, and simulation, just to name a few. NP programs continue to struggle with the education practice gap between theory and the actual provision of care. The discussion about novel and reliable methods for measurement of competencies must address the strategic importance of a consensus about when, where, and how students can obtain the appropriate amount and type of experience and supervision required in the transition to independent practice. There is also a significant need for processes and standardized guidelines that can contribute to EPA development.

The future of general surgery training: A Canadian resident nationwide Delphi consensus statement.

BACKGROUND: Several models have been introduced to improve and restructure surgical training, but continued barriers exist. Residents are uniquely positioned to offer perspective on practical challenges and needs of reformatting surgical education. This study aimed to establish a nationwide, Delphi consensus statement on the perceptions of Canadian residents regarding the future of general surgery training. METHODS: Canadian general surgery residents participated in a moderated focus group using the Nominal Group Technique to discuss early subspecialization, competency-based medical education, and transition to practice. Qualitative verbal data were transcribed, categorized into themes, and synthesized into recommendation statements. During an iterative Delphi survey, resident leaders ranked each statement on a 5-point Likert scale of agreement. The survey was terminated once consensus was achieved (≥2 survey rounds and Cronbach's α ≥ 0.80). RESULTS: A total of 66 statements were synthesized by 16 members of the Canadian Association of General Surgeons Resident Committee. A total of 49 residents participated in the Delphi consensus, which was achieved after 2 voting rounds (Cronbach's α = 0.93). Participants agreed that (1) residency should focus on achieving standardized competencies and milestones based on resident ability to meet specific measurable metrics, (2) early streaming should be offered after "core" milestones and competencies have been achieved, and (3) an explicit period should allow transition-to-independent practice with tailored rotations, greater autonomy, and resident-run clinics. We identified 10 barriers to competency-based medical education implementation. CONCLUSION: A nationwide consensus regarding the future of surgical training was established among current residents. These findings can inform and help implement guidelines and national curricula that meet the needs of the trainee and address the many challenges they face during their training.

Pairing pedagogical and genomic advances to prepare advanced practice nurses for the era of precision health.

BACKGROUND: Broadly accessible curriculum that equips Advanced Practice Nurses (APNs) with knowledge and skills to apply genomics in practice in the era of precision health is needed. Increased accessibility of genomics courses and updated curriculum will prepare APNs to be leaders in the precision health initiative. METHODS: Courses on genomics were redesigned using contemporary pedagogical approaches to online teaching. Content was based on the Essential Genetic and Genomic Competencies for Nurses with Graduate Degrees. RESULTS: The number of students enrolled (n = 10) was comparable to previous years with greater breadth of representation across nursing practice specialty areas (53% vs. 20%). Prior to the first course, students reported agreement with meeting 8% (3/38) of the competencies. By completion of the 3rd course, students reported 100% (38/38) agreement with meeting the competencies. CONCLUSIONS: Content on genomics sufficient to obtain self-perceived attainment of genomics competencies can be successfully delivered using contemporary pedagogical teaching approaches.

A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011-2018.

PURPOSE: This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. METHOD: Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS: In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6-41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency-based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6-32). CONCLUSIONS: This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum.

Implementing a competency-based midwifery programme in Lesotho: A gap analysis.

Global reforms in health professions education, including midwifery, support the transformation of education programmes to adopt competency-based models. Lesotho, a small sub-Saharan African country, with perennially high maternal and neonatal mortality, adopted a competency-based education model in the design and subsequent implementation of a one-year post-basic midwifery programme. Through a gap analysis involving administrators, educators and students in all the nursing education institutions in Lesotho, we explored their experiences related to the implementation of a competency-based midwifery programme after three years of continuous implementation. The findings revealed a vast gap between the described curriculum, and what was enacted in the nursing education institutions. The essential components of the midwifery programme had not been transformed to accommodate competency-based education. We argue that structural and operational elements of a programme should be adjusted before and during the implementation of such a curriculum innovation to enhance a positive teaching and learning experience, further sustaining the programme. Therefore, contextually relevant frameworks aimed at supporting the implementation and sustainability of the entire programme should be developed.