[Competence-based assessment in the national licensing examination in Germany]. / Kompetenzorientiert prüfen im Staatsexamen Medizin.

In Germany, future physicians have to pass a national licensing examination at the end of their medical studies. Passing this examination is the requirement for the license to practice medicine. The Masterplan Medizinstudium 2020 with its 41 measures aims to shift the paradigm in medical education and medical licensing examinations.The main goals of the Masterplan include the development towards competency-based and practical medical education and examination as well as the strengthening of general medicine. The healthcare policy takes into account social developments, which are very important for the medical education and licensing examination.Seven measures of the Masterplan relate to the realignment of the licensing examinations. Their function to drive learning should better support students in achieving the study goal defined in the German Medical Licensure Act: to educate a medical doctor scientifically and practically who is qualified for autonomous and independent professional practice, postgraduate education and continuous training.

[Competence-based catalogue of learning objectives for conducting medical consultations]. / Kompetenzbasierter Lernzielkatalog ¼Ärztliche Gesprächsführung« .

ISSUE: In 2012 the German medical licensure regulations (Approbationsordnung) made teaching and assessing the conduction of medical consultations a mandatory part of medical education. A catalogue of learning objectives (LO) based on existing references was developed to assist medical schools in meeting this requirement. METHODS: A body of relevant material was compiled using literature research and surveying experts. Then, in a multiphase Delphi process, this was evaluated and condensed by an interdisciplinary working group in dialogue with external (clinical) experts. Competence levels and examples of clinical application were assigned to enhance implementation. The catalogue was revised by the medical faculties, professional associations and the BVMD. RESULTS: This learning catalogue comprised 116 learning objectives for the specific skills necessary to conducting medical consultations as well as exemplary application contexts. The catalogue proved to be practical in terms of developing curricula and networking at medical schools. DISCUSSION: This catalogue of learning objectives can serve as the basis for developing a sample communication curriculum for use by medical faculties.

Competence-based curricula for the education of speech-language pathologists and audiologists in Brazil.

OBJECTIVE: The aim of this paper is to present the academic requirements for the education of speech-language pathologists (SLPs) and to discuss some of the challenges in providing quality supervised practice and the solutions proposed by some programs in Brazil. METHODS: Brazilian proposals regarding the training of SLPs are reviewed, with guidelines provided by the International Association of Logopedics and Phoniatrics (IALP) and the Comité Permanent de Liaison des Orthophonistes-Logopèdes de l'UE (CPLOL), and descriptions of the specific experience of the oldest Brazilian program are provided. RESULTS: The bachelor's degree is the minimum level required for the independent practice of speech-language pathology and audiology in Brazil, where there are 75 undergraduate programs. In several programs, students are encouraged to enjoy the diversity at their university, enrolling in courses of different areas to broaden their experience. The basic areas of the undergraduate program are mandatory as per recommendation of the Ministry of Education and include competences related to the health system, decision making, communication, leadership and continued education. Since practice training is part of the undergraduate programs, it is incorporated into the pedagogical concept and has a major role in it. CONCLUSION: The structure of the programs allows the dissociation of theory from practice to be attenuated; both educational strategies are used together as part of the pedagogical concept.

The Australian General Practice Training program--reflections on the past decade.

How has general practice vocational training progressed towards the original goals established by the federal government and General Practice Education and Training 10 years ago?

The evolution of general practice training in Australia.

Training for general practice in Australia has undergone a 60-year evolutionary process punctuated by revolutionary events. The discipline of general practice has also evolved significantly over this period. Today's Australian general practice training program strongly resembles its ancestors, with adaptations that better suit its regionalised environment. General practice training has been affected frequently by political and professional forces. Many of these forces were powered by the government's need for general practice training to deliver immediate workforce solutions, and the profession's struggle to respond. Pressure on general practitioners to train increasing numbers of clinical learners is challenging traditional apprenticeship models. The Australian general practice training program needs to continue to evolve if it is to remain successful within its volatile environment.

Competency model for dentists in China: Results of a Delphi study.

OBJECTIVE: With the increasing awareness of the importance of oral health, patients have an increasing need for integrated care from dentists. In China, the dentistry examination consists of two parts: a practical skills examination and a comprehensive medical examination; to date, no assessment methods that are based on specialized dentistry competencies, unlike the United States, Canada, and other countries, have been established. Therefore, the purpose of this study was to construct a competency model for dentists in China in order to guide the development, admission, training and assessment of dentists. METHODS: Using a literature review, focus group interviews and in-depth personal interviews, a dentist competency index was developed with an expert consultation questionnaire. A panel of 20 specialist experts was chosen from ten national medical universities to carry out two rounds of Delphi expert analysis, using the boundary value method to filter the indicators and the Analytic Hierarchy Process to calculate the weights of the primary indicators. RESULTS: Two rounds of Delphi results showed that the expert authority, enthusiasm, and coordination coefficients were high. Constructs of the competency model that included seven primary indicators and 62 secondary indicators determined the weight of each index. The seven primary indicators included the following: clinical skills and medical services, disease prevention and health promotion, interpersonal communication skills, core values and professionalism, medical knowledge and lifelong learning ability, teamwork ability and scientific research ability. CONCLUSION: In conclusion, the use of the Delphi method to construct an initial model of Chinese physician competency is scientific and feasible. The initial competency model conforms to the characteristics and quality requirements of dentists in China and has a strong scientific basis. The dentist competency model should be used in the National Dental Licensing Examination in China.

What Regulatory Requirements and Existing Structures Must Change If Competency-Based, Time-Variable Training Is Introduced Into the Continuum of Medical Education in the United States?

As competency-based medical education is adopted across the training continuum, discussions regarding time-variable medical education have gained momentum, raising important issues that challenge the current regulatory environment and infrastructure of both undergraduate and graduate medical education in the United States. Implementing time-variable medical training will require recognizing, revising, and potentially reworking the multiple existing structures and regulations both internal and external to medical education that are not currently aligned with this type of system. In this article, the authors explore the impact of university financial structures, hospital infrastructures, national accrediting body standards and regulations, licensure and certification requirements, government funding, and clinical workforce models in the United States that are all intimately tied to discussions about flexible training times in undergraduate and graduate medical education. They also explore the implications of time-variable training to learners' transitions between medical school and residency, residency and fellowship, and ultimately graduate training and independent practice. Recommendations to realign existing structures to support and enhance competency-based, time-variable training across the continuum and suggestions for additional experimentation/demonstration projects to explore new training models are provided.

Visions and reality: the idea of competence-oriented assessment for German medical students is not yet realised in licensing examinations.

Objective: Competence orientation, often based on the CanMEDS model, has become an important goal for modern curricula in medical education. The National Competence Based Catalogue of Learning Objectives for Undergraduate Medical Education (NKLM) has been adopted in Germany. However, it is currently unknown whether the vision of competence orientation has also reached the licensing examination procedures. Methods: Therefore, a prospective, descriptive, single-centre, exemplary study design was applied to evaluate 4051 questions/tasks (from 28 examiners at 7 two-day licensing oral-practical exams) for undergraduate medical students at the University of Ulm. The oral and practical questions/tasks as well as the real bedside assessment were assigned to specific competence roles (NKLM section I), categories (NKLM section II) and taxonomy levels of learning domains. Results: Numerous questions/tasks were set per candidate (day 1/2: 70±24/86±19 questions) in the licensing oral-practical exam. Competence roles beyond the "medical expert" were scarcely considered. Furthermore, practical and communication skills at the bedside were hardly addressed (less than 3/15 min). Strikingly, there was a significant predominance of questions with a low-level taxonomy. Conclusions: The data indicate a misalignment of competence-oriented frameworks and the "real world" licensing practical-oral medical exam, which needs improvement in both evaluation and education processes.

Estágio em serviço público de saúde: percepções de estudantes de Odontologia e consonância com propostas curriculares / Internship in public health services: dental students' perceptions and consonance with curricular proposals

O estágio supervisionado em serviço público de saúde é o momento no qual o estudante pode colocar em prática toda a sua carga recebida de teoria em diferentes cenários comunitários. A proposta deste estudo foi analisar se a percepção dos estudantes do curso de Odontologia acerca dessa modalidade de estágio está de acordo com os objetivos de aprendizagem da disciplina de Estágio Supervisionado em Serviço de Saúde (ESSS) de uma universidade privada de Curitiba/PRe com as Diretrizes Curriculares Nacionais (DCN). O desenho desteestudo foi o transversal quali-quantitativo. Uma amostra de conveniência contou com 135 estudantes do último ano do curso, de ambos os gêneros e turnos, que haviam concluído a disciplina de ESSSno ano de 2018. Os participantes responderam a um questionário padrão, o qual é entregue ao término do estágio. As perguntas abertas foram analisadas por meio da análise de conteúdo proposta por Bardin e as categorias de análises foram estruturadas de acordo com as competências gerais descritas nas DCN: atenção à saúde, tomada de decisão, comunicação, liderança, administração e gerenciamento e educação permanente. A questão fechada foi analisada, quantitativamente, pela medida de frequências, em SPSS versão 21.0. Os estudantes afirmaram que puderam desenvolver habilidades e competências quecorroboram o disposto nos objetivos de aprendizagem da disciplina de ESSS e nas DCN. A classificação do estágio como excelente foi feita por 80,0% dos pesquisados.Concluiu-se que a percepção dos estudantes acerca do estágio está em consonância com o proposto nos documentos que o norteiam (AU).

Supervised internshipsin public health servicesarethe moment when studentscan put into practice in different community settingsall the theory they have learned. The purpose of this study was to analyze whetherdental students'perceptions about this type of internshiparein accordance with the learning objectives of theSupervised Health Service Internship(SHSI) disciplineand the National Curriculum Guidelines (NCG)(Diretrizes Curriculares Nacionais)for Dentistry. This study had a mixed qualitative and quantitative cross-sectionaldesign. A convenience sample of 135 students from the final year of the course, of both genders and from each of the two course shifts, had finishedtheir(SHSI) in 2018. Participants completed a standard questionnaire, which is administered at the end of the internship. The answers to the open-endedquestions were analyzed using content analysis as proposed by Bardin and the categories of analysis were structured according to the general competencies described in the NCG: health care, decision making, communication, leadership, administration and management,and continuing education. The answers to the closed-endedquestion wereanalyzed quantitatively by measuring frequencies in SPSSversion 21.0. The students stated that they were able to develop skills and competencies in keeping with the provisions of thelearning objectives of the SHSIdiscipline and the NCG. The internshipwas classified as excellent by 80.0% of respondents. The conclusion was reached that the students' perception about the internshipis in line with what is proposed in the documents that guide it (AU).

Making the transition to postsecondary education and training.

A nationally representative sample of youth with disabilities who recently exited high school was studied to determine the participation of the youth in postsecondary educational programs. The results show that youth with disabilities participate in postsecondary programs at only one-quarter the rate attained by their counterparts without disabilities and at only one-third the rate attained by economically disadvantaged youth. The relationship of postsecondary education for youth with disabilities to long-term success in employment is yet to be determined.

El examen MIR, su cambio como una opción estratégica / The MIR examination, the change as a strategic option

El examen MIR es un punto estratégico capaz de promover cambios en cascada en su entorno, con repercusiones tanto en la etapa de licenciatura como en la de especialización. Actualmente, la implantación de un nuevo currículo basado en competencias y las nuevas metodologías de entrenamiento y evaluación, aconsejan adecuar el examen MIR a las necesidades actuales. El rediseño del examen MIR requiere incrementar el número de preguntas y apoyarlas con iconografía, y relacionarlas con competencias predeterminadas, a la vez que se incorpora la evaluación objetiva de habilidades. Este cambio requiere más tiempo para realizar los exámenes, una gestión más ágil, equipos multidisciplinares de diseño y centros acreditados. El soporte informático debe dar cobertura al 100% de las actividades del examen MIR. La equidad, la transparencia y la accesibilidad deben ser los valores del examen MIR (AU)

The MIR examination constitutes a strategic point which is capable of promoting cascading changes in its environment with repercussions at both the undergraduate and specialisation stages. At present, the implementation of a new skills-based syllabus and new training and evaluation methodologies make it necessary to adapt the MIR examination to current needs. The redesign of the MIR examination requires an increase in the number of questions; these must be supported with iconography and related to predetermined competences along with the incorporation of objective skills evaluation. This change requires more examination time, more efficient management, multidisciplinary design teams and accredited centres. Information technology support must provide 100% cover to the MIR examination activities. Equity, transparency and accessibility must be the values of the MIR examination (AU)

Evaluación de competencias médicas en un currículo de grado no diseñado por competencias / Assessment of medical competences in an undergraduate curriculum not designed for developing competences

Introducción. En 2005 se definieron y difundieron seis competencias con 27 componentes para la carrera de medicina. Objetivos. Evaluar los instrumentos de evaluación de los aprendizajes que se utilizan durante la carrera, formar docentes en la elaboración y uso de instrumentos adecuados, válidos y fiables con el fin de evaluar competencias médicas, y formular criterios generales para la evaluación de los aprendizajes. Materiales y métodos. Se trabajó sobre una muestra de 17 asignaturas, pertenecientes a cuatro grupos. Se recogieron muestras de sus instrumentos de evaluación, que se analizaron según su validez, fiabilidad y capacidad de evaluar competencias médicas, en un estudio descriptivo y cuali-cuantitativo. Varios instrumentos de evaluación de las asignaturas no resultaron válidos ni fiables. Pocos evaluaban las competencias médicas. Se devolvieron resultados y se trabajó en la capacitación de docentes de cuatro de esas asignaturas, cuyos sistemas de evaluación mejoraron considerablemente. Se elaboraron cinco criterios generales para el diseño de sistemas de evaluación de competencias médicas válidos y fiables. Resultados y conclusiones. a)Muchos de los instrumentos de evaluación del aprendizaje que se utilizan en la carrera no son válidos ni fiables; b) son pocas las competencias médicas definidas para la carrera que se evalúan en las rotaciones clínicas, aun cuando gran cantidad de docentes participaron de su formulación; c)capacitando al personal docente se logra que produzcan instrumentos de evaluación válidos, fiables y orientados a evaluar las competencias médicas; d) la facultad deberá esforzarse en desarrollar programas de capacitación docente (AU)

Introduction. Six medical competences with 27 components were defined for the undergraduate medical program in2005. Aims. To evaluate the learning assessment tools that are used through the program, to develop faculty for working out and using reliable and valid assessment tools, in order to control medical competences, and to formulate learning assessment criteria. Materials and methods. In a descriptive, quali-quantitative study, a sample of 17modules, belonging to four different groups of courses was chosen. Samples of different evaluation tools of those modules were collected and analyzed in terms of validity, reliability and capability to evaluate medical competences. After given back the data to faculty and developed a training program for four modules’ teaching teams, their assessment system considerably improved. Five general criteria were developed to design a valid and reliable system of medical competences assessment. Results and conclusions. a)Many of the learning assessment tools that are used in the program are nor valid neither reliable, particularly those used in clerkships; b) even though many faculty members were part of the medical competences drafting process, a few competences’ compounds are effectively assessed; c) training faculty is enough to have them build up valid, reliable and competence oriented assessment tools; d) the Medical School should set up faculty development programs (AU)

La acreditación de la Formación Médica Continuada. Hechos y controversias / The accreditation of Continuing Medical Education. Facts and controversies

La acreditación de la formación médica continuada (FMC) tiene como objetivo esencial la mejora de la oferta formativa, por encima de otros objetivos complementarios como servir de guía a los distintos agentes, atestiguar la participación en los programas formativos, orientar la oferta o reconocer la cualificación de los proveedores. De los tres ámbitos tradicionales de la acreditación, la acreditación individual debe separarse claramente, equiparándose a lo que se conoce como revalidación. Los otros dos ámbitos genuinos de acreditación de la FMC son la acreditación de actividades formativas la acreditación de instituciones proveedoras. Los créditos de FMC sirven para tres cometidos fundamentales: la carrera profesional, la revalidación el desarrollo profesional continuo. Adicionalmente, pueden utilizarse para otras finalidades relacionadas con la promoción profesional individual. La situación de la acreditación de la FMC en España esmuí esperanzadora, con dos sistemas de acreditación que disponen de una relativamente larga trayectoria y unas expectativas que lo sitúan en una posición avanzada a nivel europeo (AU)

The main objective of continuing medical education (CME) accreditation is to improve the CME offer, being other additional objectives to serve as orientation of the different agents, to certify the attendance of participants, to orient the CME offer and to recognise the quality of CME providers. Among the three traditional domains of the accreditation, the accreditation of the individuals must be clearly separated and should be identified to revalidation. The other two genuine domains of the CME accreditation are the CME activities accreditation and the CME providing institutions accreditation. The CME credits are useful for three particular professional developments: professional career, revalidation and continuing professional development. Additionally one can use them for other individual promotion purposes. The CME accreditation situation in Spain is currently encouraging, with two accreditation systems actively implemented into practice and with good expectations in the European context (AU)

El nuevo grado en farmacia ¿cubre las necesidades formativas en el ámbito de la nutrición? / The new degree in pharmacy. Is it enough for the formative needs in the nutrition area?

La importancia de la alimentación en la consecución de la salud y en la prevención de la enfermedad y la necesidad de un buen control de la dieta para alcanzar resultados satisfactorios en la reducción del riesgo, tratamiento y control de muchas de las enfermedades crónicas, es un hecho documentado científicamente y de gran relevancia en la sociedad actual. La Orden CIN/2137/2008, de 3 de julio establece los requisitos para la verificación de los títulos universitarios oficiales que habiliten para el ejercicio de la profesión farmacéutica, abarcando diversas competencias que aluden directamente a la formación del farmacéutico en el campo de la nutrición. Entre ellas se incluyen 1) Prestar consejo terapéutico en farmacoterapia y dietoterapia, así como consejo nutricional y alimentario a los usuarios de los establecimientos en los que presten servicio. 2) Conocer la relación existente entre la alimentación y salud, y la importancia de la dieta en el tratamiento y prevención de las enfermedades. 3) Desarrollar análisis higiénico-sanitarios (bioquímico, bromatológico, microbiológicos, parasitológicos) relacionados con la salud en general y con los alimentos y medio ambiente en particular. 4) Conocer las técnicas analíticas relacionadas con el diagnóstico de laboratorio de tóxicos, alimentos y medioambiente. En este sentido, el nuevo Grado en Farmacia aprobado por el Consejo de Gobierno de la Universidad de Granada incluye la asignatura troncal “Nutrición y Bromatología” de 6 créditos. Sin embargo los créditos obligatorios aprobados por la ANECA para esta materia en 8 Universidades Españolas oscilan entre 7,5 para Sevilla y 12 créditos para Madrid con una media de 9,4 créditos. De esta forma ¿Es posible cubrir con los 6 créditos asignados a esta materia una formación mínima para que el farmacéutico pueda realizar adecuadamente las competencias que se le han asignado?(AU)

The importance of nutrition on human health and on illness prevention, and the need for a good control of the diet to reach satisfactory results in the reduction of the risk, treatment and control of many of the chronic diseases, is a scientifically documented fact quite relevant in the current society(AU)

Perfil del farmacéutico en el ámbito de la nutrición a nivel europeo / Pharmacist role in the nutrition area at the European level

Una vez licenciado, el farmacéutico puede optar por un elevado número de salidas profesionales, tanto en el sector público al servicio de los diferentes cuerpos y administraciones, como en el sector privado. Los perfiles profesionales más frecuentes del farmacéutico pueden englobarse en 4 modalidades: Oficina de Farmacia (Farmacia Comunitaria), Farmacia Hospitalaria, Distribución e Industria Farmacéutica o Análisis y Salud Pública. A nivel de oficina de farmacia, el farmacéutico, junto a la dispensación de medicamentos, ejerce un destacado papel como asesor y consejero de salud. Las estadísticas desvelan que una de cada cuatro personas que entran en una farmacia no adquiere medicamentos, sino que sólo pide un consejo sanitario, incluyendo asesoría sobre dietas, alimentación y nutrición. Además, la aparición en los últimos años de complementos alimenticios, de venta en farmacia, hace que el farmacéutico deba formarse y comportarse como profesional en lo que respecta a temas de nutrición. Otra salida profesional, como la inspección Farmacéutica, incluye la supervisión de agua y alimentos no animales, por lo que el farmacéutico debe tener un amplio conocimiento sobre la legislación, sanidad y análisis de alimentos. Por otro lado, la industria farmacéutica incluye una amplia variedad de salidas profesionales, incluyéndose dirección técnica, control de calidad y de fabricación, gestión comercial, documentación científica o análisis. La industria agroalimentaria ha experimentado importantes cambios en las últimas décadas, exigiendo profesionales en la materia, como dietistas o analistas bromatológicos, dentro de un equipo multidisciplinar. En este sentido, el farmacéutico, a través del nuevo grado en Farmacia, debe adquirir una base sólida en el campo de la nutrición y bromatología. Así, las competencias recogidas en la Orden CIN/2137/2008 ponen de manifiesto la importancia de la formación del futuro farmacéutico en el ámbito de la alimentación(AU)

Once graduated, the pharmacist can choose a high number of professional skills, both in public and private sectors. The most frequent professional skills of the pharmacist can be included in 4 different fields: Pharmacy Office (Communitary Pharmacy), Hospital Pharmacy, Distribution andPharmaceutical Industry or Analysis and Public Health. At the pharmacy office level, the pharmacist, along with the medicines dispensation, exercises an out-standing role as health adviser. The statistics reveal that 25% of the pharmacy customers do not acquire medicines, but they only ask for a sanitary advice, including nutrition and dietetic consultations. Moreover, in the last years nutritive supplements have been included within the pharmaceutical sales. Thus, the pharmacist should be formed about nutritional topics. Another professional skill, like the pharmaceutical inspection, includes drinkable water and non-animal foodstuffs analyses. Then, the pharmacist should have a wide knowledge on legislation, health and food analysis. On the other hand, the pharmaceutical industry includes a wide variety of professional skills, including technical direction, quality control, commercial management, scientific documentation or analysis. Finally, the agro-alimentary industry has experienced important changes in the last decades, demanding professionals in the matter, like dietitians or food analysts. In this sense, the pharmacist, across the new degree in Pharmacy, must acquire a solid base in the nutrition and bromatology field. Therefore, the competences gathered in the Disposition CIN / 2137/2008 reveals the importance of the formation of the future pharmacist in the nutrition area(AU)

Gestión del conocimiento II: generación y transmisión del conocimiento / Management of knowledge II: generation and transmission of knowledge

La generación y transmisión de conocimiento es tradicional dentro de la actividad médica, pero habitualmente esta actividad ha estado poco ordenada, reglada y reconocida por la administración sanitaria. La gestión clínica viene a cambiar esto, concediendo importancia y considerando la investigación como una labor fundamental que ha de ser medida e incentivada. Para ello existe un marco legislativo que, desde la Ley General de Sanidad y la Ley de Salud de Andalucía, lo recoge. Además, diversos planes de ordenación y fomento de la investigación dirigen la investigación biomédica, al igual que distintas instituciones públicas y privadas la financian. La administración sanitaria ha creado unas herramientas que favorecen y ayudan a los investigadores a la generación y transmisión del conocimiento. Con todo esto, las unidades de gestión clínica deben incluir la investigación dentro de sus objetivos, y planificar sus acciones en los marcos legislativos, siguiendo las líneas marcadas por los planes y aprovechando las herramientas y financiación que se ofrece, siendo conscientes de cómo esta labor de generación y transmisión del conocimiento influye en la gestión de calidad de la unidad y en la gestión por competencia de sus profesionales (AU)

The generation and transmission of knowledge is traditional within the medical activity. However, this activity has generally lacked organization, regulation and recognition by the health care administration. Clinical management chances this by granting it importance and by considering research as a fundamental work that must be measured and given incentives. This is done within a legislative framework, which is included in both the General Law of Public Health and the Public Health Law of Andalusia. In addition, several plans for the regulation and promotion of research plans govern biomedical research, and different public and private institutions finance it. The Public Health Administration has created tools that favor and help the investigators in the generation and transmission of knowledge. Thus, the Clinical Management Units should include research within their objectives. They should plan their actions within the legislative frameworks, following the lines indicated by the plans and taking advantage of the tools and financing offered. They should be aware of how this work of generating and transmitting knowledge influences the management of quality of the Union and the management by competence of their professionals (AU)