implications of competency based education deborah e. powell, m.d. dean of the medical school...
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IMPLICATIONS OF COMPETENCY BASED EDUCATION
DEBORAH E. POWELL, M.D.DEAN OF THE MEDICAL SCHOOL
ASSISTANT VICE PRESIDENT FOR CLINICAL SCIENCESUNIVERSITY OF MINNESOTA
GROUP ON RESIDENT AFFAIRS SPRING MEETING
VANCOUVER, BC
APRIL 18, 2004
THEMES
1. THE CORE COMPETENCIES AND THE FRAMEWORK SURROUNDING THEM
2. COMPETENCIES IN THE CONTEXT OF MEDICAL EDUCATION
3. FAR REACHING IMPLICATIONS
DREYFUS MODEL
STAGES IN HUMAN SKILL ACQUISITION
BASED ON STUDIES OF AIRPLANE PILOTS, CHESS PLAYERS, AUTOMOBILE DRIVERS, AND ADULT LEARNERS OF A SECOND LANGUAGE
DREYFUS MODEL
NOVICE
ADVANCED BEGINNER
COMPETENT
PROFICIENT
EXPERT
DREYFUS MODEL PROGRESSIONS
NOVICE EXPERT
*ABSTRACT PRINCIPLES *PAST CONCRETE EXPERIENCES
*SITUATIONS ARE EQUALLY *SITUATIONS ARE
RELEVANT BITS WHOLES WITH CERTAIN RELEVANT PARTS
*DETACHED OBSERVER *INVOLVED PARTICIPANTS
COMPETENCE
THE QUALITY OR STATE OF BEING FUNCTIONALLY ADEQUATE OR OF HAVING SUFFICIENT KNOWLEDGE, JUDGMENT, SKILL, OR STRENGTH
ACGME GENERAL COMPETENCIES
1. PATIENT CAREPROVIDE COMPASSIONATE, APPROPRIATE & EFFECTIVE PATIENT-FOCUSED (CENTERED) CARE
2. MEDICAL KNOWLEDGEAPPLY KNOWLEDGE OF ESTABLISHED AND EVOLVING BIOMEDICAL, CLINICAL, EPIDEMIOLOGICAL AND SOCIAL-BEHAVIORAL SCIENCES TO PATIENT CARE
3. PRACTICE-BASED LEARNING & IMPROVEMENTEVALUATE PATIENT CARE PRACTICES, APPRAISE AND ASSIMILATE SCIENTIFIC EVIDENCE AND IMPROVE PATIENT CARE PRACTICES
ACGME GENERAL COMPETENCIES CONTINUED
4. INTERPERSONAL & COMMUNICATION SKILLSDEMONSTRATE EFFECTIVE INFORMATION EXCHANGE AND TEAMING WITH PATIENTS, THEIR FAMILIES, AND PROFESSIONAL ASSOCIATES
5. PROFESSIONALISMDEMONSTRATE COMMITMENT TO PROFESSIONAL RESPONSIBILITY, ADHERENCE TO ETHICAL PRINCIPLES, AND SENSITIVITY TO A DIVERSE PATIENT POPULATION
6. SYSTEMS BASED PRACTICEDEVELOP AWARENESS OF AND RESPONSIVENESS TO THE LARGER CONTEXT AND SYSTEM OF HEALTH CARE AND UTILIZE THIS EFFECTIVELY TO PROVIDE CARE OF OPTIMAL VALUE
AMERICAN BOARD OF MEDICAL SPECIALTIES
ENDORSES SIX ACGME COMPETENCIES AS THOSE NEEDED BY PRACTICING PHYSICIANS IN EVERY SPECIALTY
EACH SPECIALTY BOARD WILL REQUIRE RECERTIFICATION OF ITS DIPLOMATES
RECERTIFICATION SHOULD INCLUDE EVALUATIONS OF THE SIX CORE COMPETENCIES
WHAT IF...
WE MADE THE SIX CORE COMPETENCIES THE COMPETENCIES FOR THE EDUCATION OF A PHYSICIAN
?
CONTINUUM OF MEDICAL EDUCATION
COLLEGE UNDERGRADUATEPREREQUISITES MEDICAL
EDUCATION (UME)
GRADUATE MEDICAL EDUCATION (GME)
CONTINUING MEDICAL EDUCATION (CME)
Educational Program ObjectivesUniversity of Minnesota Medical SchoolGraduates of the University of Minnesota Medical School should be able to:
OBJECTIVE OUTCOME MEASURES ACGME ESSENTIAL COMPETENCY
1. Demonstrate mastery of key concepts and principles in the basic sciences and clinical disciplines that are the basis of current and future medical practice.
USMLE Steps 1 and 2 Year 1 and 2 course performance, based on
standardized examinations Clinical rotation performance Feedback from residency directors
Medical Knowledge
2. Demonstrate mastery of key concepts and principles of other sciences and humanities that apply to current and future medical practice, including epidemiology, biostatistics, healthcare delivery and finance, ethics, human behavior, nutrition, preventive medicine, and the cultural contexts of medical care.
USMLE Steps 1 and 2 Course performance (especially in Physician and
Society, Nutrition, and Human Behavior at Twin Cities (TC) campus; Medical Sociology, Medical Epidemiology and biometrics, Family Medicine I, Medical Ethics, Human Behavioral Development and Problems, and Psycho-Social-Spiritual Aspects of Life-Threatening Illness at Duluth (DU) campus
Clinical rotation performance Feedback from residency directors
Medical Knowledge
3. Competently gather and present in oral and written form relevant patient information through the performance of a complete history and physical examination.
Year 2 Objective Structured Clinical Exams (OSCE) Physician and Patient (PAP) course performance at
TC campus, assessed by tutors using global rating forms and observed practical exams
Course performance at DU campus in Applied Anatomy, Clinical Rounds & Clerkship (CR&C), Clinical Pathology Conference, and Integrated Clinical Medicine
Clinical rotation performance
Patient CareInterpersonal and
Communication Skills
Educational Program Objectives Continued
OBJECTIVE OUTCOME MEASURES ACGME ESSENTIAL COMPETENCY
4. Competently establish a doctor-patient relationship that facilitates patients’ abilities to effectively contribute to the decision making and management of their own health maintenance and disease treatment.
Year 2 OSCE and Primary Care Clerkship (PCC) OSCE
PAP course performance at TC campus, assessed by tutors using global rating forms and observed practical exams
Preceptorship and CR&C course performance at DU campus
Clinical rotation performance
Patient Care Interpersonal and
Communication Skills
5. Competently diagnose and manage common medical problems in patients.
PCC OSCE Clinical rotation performance
Medical KnowledgePatient Care
6. Assist in the diagnosis and management of uncommon medical problems; and, through knowing the limits of her/his own knowledge, adequately determine the need for referral.
Clinical rotation performance Documented achievement of procedural skills in the
Competencies Required for Graduation
Medical KnowledgePatient CarePractice-Based
Learning and Improvement
7. Begin to individualize care through integration of knowledge from the basic sciences, clinical disciplines, evidence-based medicine, and population-based medicine with specific information about the patient and patient’s life situation.
Clinical rotation performance Feedback from residency directors
Patient CareMedical KnowledgeInterpersonal and
Communication Skills
Professionalism
QUESTIONS AND CONCERNS
FOR A SPECIFIC SKILL OR OBJECTIVE, WHAT LEVEL OF COMPETENCE IS EXPECTED FOR:
A SECOND YEAR MEDICAL STUDENT?
A FOURTH YEAR MEDICAL STUDENT?
A RESIDENT IN THEIR FIRST YEAR?
A RESIDENT IN THEIR FINAL YEAR?
A SPECIALIST BEING RECERTIFIED?
WHAT IF...
AN INTERNAL MEDICINE CLERKSHIP DIRECTOR AND AN INTERNAL MEDICINE
PROGRAM DIRECTOR PLANNED A CURRICULUM FOR INTERNAL MEDICINE
TRAINING TOGETHER?
WHAT IF...
WE PLANNED FOR THE EDUCATION OF A PHYSICIAN (SURGEON, FAMILY PHYSICIAN, PEDIATRIC OPHTHALMOLOGIST, ETC.) NOT THE EDUCATION OF A MEDICAL STUDENT, A
RESIDENT, A FELLOW
?
WHAT IF...
WE DEVELOPED CRITERIA AND APPROPRIATE ASSESSMENT TOOLS FOR
COMPETENCE
?
QUESTIONS AND CONCERNS
STANDARDS OF COMPETENCE:
ARE THEY INSTITUTION SPECIFIC?
ARE THEY SPECIALTY SPECIFIC?
WHO WILL DEVELOP THEM?
COMPETENCE
WHAT INDIVIDUALS KNOW OR ARE ABLE TO DO IN TERMS OF KNOWLEDGE, SKILLS, ATTITUDE
CAPABILITY
EXTENT TO WHICH INDIVIDUALS CAN ADAPT TO CHANGE, GENERATE NEW KNOWLEDGE, AND
CONTINUE TO IMPROVE THEIR PERFORMANCE
Brit. Med. J. 323:799-803, 2001
WHAT IF...
WE EDUCATED FOR CAPABILITY AS WELL AS COMPETENCE
?
QUESTIONS AND CONCERNS
WILL EMPHASIS ON EDUCATING FOR COMPETENCE AND CAPABILITY CHANGE THE FACULTY/STUDENT RELATIONSHIP?
COMPLEXITY CONCEPTS APPLICABLE TO EDUCATION AND TRAINING
NEITHER THE SYSTEM NOR ITS EXTERNAL ENVIRONMENT ARE, OR EVER WILL BE, CONSTANT
INDIVIDUALS WITHIN A SYSTEM ARE INDEPENDENT AND CREATIVE DECISION MAKERS
UNCERTAINTY AND PARADOX ARE INHERENT WITHIN THE SYSTEM
PROBLEMS THAT CANNOT BE SOLVED CAN NEVERTHELESS BE “MOVED FORWARD”
SMALL CHANGES CAN HAVE BIG EFFECTS
INCREASING COMPLEXITY IN HIGHER EDUCATION
Traditional education and training The future for education and training
Knowledge Knowledge is static, finite, linear, and private
Knowledge is dynamic, open ended, multidimensional, and public
Learning Instructivist model (“facts” are transmitted from teachers to students)
Constructivist model (concepts are acquired, built, and modified through social discourse, incorporated into appropriate schemes, and tested in action)
The teacher “Sage on the stage” “Guide on the side”
Student experience Generally precedes definitive career choices and personal relationships
Lifelong learning means that education converges with (and is influenced by) work, family, and personal development
Assessment Based on reproduction of facts Based on analysis, synthesis, and problem solving
Curriculum development
Historical model (students learn X because it’s always been included
“Outcomes” model (students learn X because employers require it as a competence)
Time and space utilization
Synchronous, mass, single location learning (e.g., lecture theatre, laboratory
Asynchronous, individualized, with networked learning support
Evaluation Teacher-focused (“what is being provided?”)
Learner-focused (“what are the learners’ needs and are they being met?”)
WHAT IF...
WE TOOK A NEW LOOK AT THE EDUCATION OF A PHYSICIAN
?
“IF THE UNITED STATES IS TO RETAIN ITS LEADERSHIP IN MEDICINE, AN UNDERSTANDING OF THE HISTORY OF AMERICAN MEDICAL EDUCATION DURING THE PAST CENTURY REVEALS THE PRINCIPLES THAT MUST BE FOLLOWED. THE KEY LIES IN RESTORING THE TATTERED SOCIAL CONTRACT BETWEEN MEDICINE AND SOCIETY. THE MEDICAL PROFESSION MUST REMEMBER THAT IT EXISTS TO SERVE; SOCIETY MUST REMEMBER THAT IT WILL NOT HAVE GOOD HEALTH CARE UNLESS IT PROVIDES THE NEEDED FINANCIAL AND MORAL SUPPORT. FORTUNATELY FOR THE UNITED STATES, THE OPPORTUNITY TO RETAIN THE WORLD’S PREMIER SYSTEM OF MEDICAL EDUCATION, RESEARCH, AND PRACTICE STILL EXISTS. THE TIME LEFT TO RECAPTURE A CONSTRUCTIVE COURSE OF ACTION IS SHRINKING, BUT THERE ARE STILL SUFFICIENT OPPORTUNITIES FOR VISIONARIES TO DREAM AND LEADERS TO ACT.”
- KENNETH LUDMERER
The EndDownload the post test and return
the completed test to Dr. Sandra Oliver
Post test one
1. Which of the following is not found in the Dreyfus model?1. NOVICE
2. SUPERIOR TRAINEE
3. COMPETENT
4. PROFICIENT
5. EXPERT
Post Test Two
2. ACGME Competencies include all of the following except:1. Provide patient focused care2. Personal communication skills3. Practice based learning and improvement4. Systems based practice
Post Test Three
Which of the following defines competence?1. What individuals know or are able to do in terms of
knowledge, skills, attitude.
2. Extent to which individuals can adapt to change, generate new knowledge and continue to improve their performance
3. The ability of individuals to proceed or progress toward a goal.
4. The disciplined ability and willingness to make objective judgments on the basis of well supported reasons as a guide to belief and action, and to monitor one’s thinking while doing so.
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