Developing a competency framework for Health Professions Education at doctoral level: The first step toward a competency based education

Enabling Factors for the Implementation of Competency-Based Curricula in Colleges and Schools of Pharmacy

OBJECTIVES

To review the implementation drivers of competency-based pharmacy education (CBPE) and provide recommendations for enablers.

FINDINGS

Competency-based education is an emerging model in the health professions, focusing on time-variable competency development and achievement compared with a time-bound, course-based, traditional model. CBPE is an outcomes-based organized framework of competencies enabling pharmacists to meet health care and societal needs. However, challenges need to be recognized and overcome for the successful implementation of CBPE. Competency drivers include defining the competencies and roles of stakeholders, developing transparent learning trajectories and aligned assessments, and establishing lifetime development programs for stakeholders. Organization drivers include developing support systems for stakeholders; facilitating connections between all educational experiences; and having transparent assessment plans, policies, and procedures that align with core CBPE precepts, including the sustainability of time-variability. Leadership drivers include establishing growth mindset and facilitating a culture of connection between workplace and educational environments, program advocacy by institutional leaders, accepting failures as part of the process, shifting the organizational culture away from learner differentiation toward competence, and maintaining sufficient administrative capability to support CBPE.

SUMMARY

The successful implementation of CBPE involves enabling the competency, organization, and leadership drivers that will lead to program success. More research is needed in the areas of creation, implementation, and assessment of CBPE to determine success in this model. We have reviewed and provided recommendations to enable the drivers of successful implementation of CBPE.

Examining Competency-Based Education Through the Lens of Implementation Science: A Scoping Review

OBJECTIVES

This study aimed to identify evidence for the implementation and assessment of competency-based education (CBE) in health professions curricula using an implementation science framework.

FINDINGS

Using the PRISMA framework, a systematic review of the literature applying a prespecified and piloted search strategy from 2017 to the present in PubMed and CINAHL was performed. References identified from the search strategy were imported into Covidence for title and abstract screening and full-text review by 2 researchers. A third researcher resolved discrepancies. Data were extracted and synthesized to identify key elements from the article related to implementation science, with a quality appraisal. A total of 25 studies out of 304 initially identified records were included. The studies covered a broad range of health professions and countries. Key findings were limited use of implementation science elements, including variability in CBE implementation, limited fidelity assessment, and partial examination of the process continuum. Programs with a more robust implementation approach have a team-based strategy to lead, implement, and support CBE. Motivation and training of faculty are also key components of successful CBE implementation.

SUMMARY

Competency-based education is implemented differently across institutions, with variation among programs in their choice of elements of implementation science used. Further research is needed to examine CBE from an implementation science perspective and address remaining questions.

Striking up a Conversation: Exploring Advising in Graduate Programs in Health Professions Education

INTRODUCTION

Advising is happening across the medical education continuum, within non-medical graduate education programs, and is central to the advancement of said learners. This suggests that advising should play a role in graduate health progressions education (HPE) programs.

MATERIALS AND METHODS

To explore advising curricula among HPE programs, we conducted a website review of all published HPE programs on the Foundation for Advancement of International Medical Education and Research's website.

RESULTS

We recognized the lack of information published on advisory roles in graduate HPE programs. This prompted a literature review, which revealed a similar gap.

CONCLUSIONS

Advising serves to benefit a student, advisor, and program thus carrying importance and need for discussion. This article is intended to kick-start a scholarly discussion about advising within graduate HPE programs.

The effect of the Educational Scholar Program as a longitudinal faculty development program on the capability of educators as scholars

INTRODUCTION

The Educational Scholar Program (ESP) is designed and implemented as a longitudinal and institution-based faculty development program. The present study aimed to assess the effect of the ESP on educators' capabilities to undertake SoTL activities associated with their scholar role.

METHODS

This study was conducted from 2017 to 2022. The participants (n = 64) were educators in six schools of Shahid Sadoughi University of Medical Sciences. The ESP was a faculty development program that consisted of training and project-based stages. The educators experienced small-group learning, self-directed learning, and reflective assignments in the training stage. In the second stage, the educators completed a SoTL (Scholarship of Teaching and Learning) project. Learner-related outcomes based on Kirkpatrick model was assessed. The reaction of educators (satisfaction, active participation in the ESP, and the perception of mentoring sessions) was assessed by three questionnaires (Reaction level). The educators' learning was evaluated by modified essay questions and their project reports (Learning and Behavior levels). Outputs of the ESP including journal publications, abstracts presented at meetings or congresses, grant funding, awards in educational festivals, promotions, projects with ongoing implementation following the ESP, and conducting further SoTL projects after ESP were assessed quantitatively over two years after participating in the ESP (Results level). Data were summarized by descriptive statistics (mean, percentage, SD, 95% Confidence Interval (CI)). Cut-off scores of the instruments was calculated with a standard setting method which introduced by Cohen-Schotanus and Van DerVleuten. Data analyzed by One-sample t-test.

RESULTS

Sixty-four of 72 (89%) educators completed the ESP. The mean (CI) satisfaction score of educators was 42 (CI: 26.92-58.28), the active participation was 92 (CI: 80.24-103.76). The scores of the mentoring assessment from the perspective of the educators were reported at 90 (CI: 78.24- 101.76). The mean (95%CI) learning scores in the essay examination were 88 (CI: 70.36- 105.64), and project assessment were 90 (CI: 78.24- 101.76). The results showed the educators' scores in reaction and learning significantly higher than the cut-off scores. (P < 0.05). Most projects were conducted in curriculum development and assessment/evaluation domains. The number of projects with ongoing implementation over the two years following the ESP and the acquisition of grants was higher than other outputs in the results level.

CONCLUSION

The ESP, as an institute-based longitudinal program, enhanced the learner-related outcomes (in four levels of reaction, learning, behavior, and results). The creation of practical learning and supportive mechanisms influenced on the results. The outcomes of ESP indicated that the educators prepared to conduct SoTL activities in their educational community.

The experiences of preparation and engagement of educators in teaching e-portfolio

INTRODUCTION

A teaching e-portfolio is used to organize the collation and presentation of documents about teaching for the development and evaluation of educators. The current study was aimed at describing teaching e-portfolio components at Shahid Sadoughi University of Medical Sciences. As well, we examined the performance and experience of educators in engaging in the teaching e-portfolio.

MATERIALS AND METHODS

This study was conducted at Shahid Sadoughi University in 2018-2022 in three main stages: (1) Development of the teaching e-portfolio; (2) Implementing teaching e-portfolio, and evaluating teaching documentation quantitatively; and (3) Exploration of educators' experiences by a conventional content analysis introduced by Graneheim and Lundman. The teaching e-portfolio was developed from the perspective of the components, domains, and criteria of scholarship of teaching and learning. The teaching e-portfolio documented the educational activities of educators in 12 areas, including philosophy of education (1 activity), curriculum planning (4 activities), evaluation (7 activities), teaching and learning (1 activity), e-learning (1 activity), professional development in education (1 activity), scholarly activities (2 activities), mentoring and counseling (3 activities), educational leadership (2 activities), education research (6 activities), education reform project (1 activity), and production of scholarship of teaching and learning (13 activities). The educators recorded the documentation of educational activities in their teaching e-portfolio. Their documentation was reviewed by two peers. The reviewers delivered constructive feedback to improve the educators' performance. The quantitative performance of educators in different activities in teaching e-portfolio was examined by descriptive tests (frequency and percentage). The experiences of educators were explored by the conventional content analysis approach which was introduced by Graneheim and Lundman.

RESULTS

In the present study, 148 educators registered in the teaching e-portfolio. A total of 1488 documents of educational activities were registered in the e-portfolio from 2018 to 2022, and 55.24% of the activities received feedback in the peer review process. The experience of participants was categorized into a theme "fear and hope in utilizing teaching e-portfolio". This theme consisted of three categories: "motivational roadmap for personal and professional development in the future", "concern about the consequences of continuous monitoring", and "restriction of resources and capability as resistance sources".

CONCLUSION

The current study showed that the participation of educators in a teaching e-portfolio was at an acceptable level. Support systems and educational policies played an effective role in guiding educators to participate in educational development activities. The educators perceived the teaching e-portfolio as a two-faceted tool. Teaching e-portfolio can provide a road map for their personal and professional development to achieve excellent teaching. As well, the teaching e-portfolio was recognized as a tool for continuous performance monitoring and detection of the inefficiency of teaching quality activities. This perception, along with limited resources such as time, weak technological literacy, and difficulty in working with electronic devices and systems, led to resistance from educators to involve in teaching e-portfolio.

Identifying characteristics of a skilled communicator in the clinical encounter

BACKGROUND

In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training.

METHOD

In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'Top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process.

RESULTS

Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self-awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient-centred communication; (F) goal-oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient.

CONCLUSIONS

We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.

Competency domains of educators in medical, nursing, and health sciences education: An integrative review

PURPOSE

Competencies for educators of healthcare professionals are important for demonstrating accountability, defining roles and responsibilities, structuring activities for training and development, defining standards, quality assurance, performance reviews, career development, and promoting the professionalisation of teaching. The frameworks and domains of educator competencies have not previously been reviewed or systematically described. Through this integrative review, the authors sought to identify an inclusive structure for competency domains that may be applied to educators.

METHODS

Keywords were identified in a pilot search, followed by a multi-database search strategy of records published from 2000 to January 2020 with subsequent backward and forward reference searches. We included all record types that listed or described educator competency domains in medical, nursing and health sciences education. We excluded records that described 'ideal traits' or 'characteristics of good teachers/educators,' presented competencies as part of a larger curricular framework, and teaching assessment tool content.

RESULTS

The multi-database search retrieved 2942 initial citations. From a full-text review of 301 records, 67 were identified as describing educator competency domains eligible for analysis. Documents contained a median of six domains (interquartile range = 5-7) and 14.9% incorporated at least one overarching element across their domains. Following an inductive thematic analysis, six distinct domains of educator competence were identified: Teaching and facilitating learning; Designing and planning learning; Assessment of learning; Educational research and scholarship; Educational leadership and management; Educational environment, quality, and safety. The two latter domains contained sub-themes that were able to be further categorised. Documents and frameworks were described for a wide variety of health and allied health disciplines.

CONCLUSION

Distinct educator competency domains were identified in this analysis, applicable across a range of healthcare disciplines. Along with the description of design elements, these provide a guide for the development and evaluation of educator competency frameworks.

Perception, knowledge and attitude towards childhood fever: A survey among final-year medical students

AIMS

Undue concerns about the consequences of fever and its inappropriate management have been documented worldwide among physicians. However, no data exist on medical students. We investigated the perception, knowledge and attitude towards childhood fever among final-year medical students.

METHODS

Between June and September 2021, final-year medical students of six Italian universities were invited to complete an online survey on their conceptions and attitude towards pharmacological and non-pharmacological management of childhood fever. History of relevant personal or second-hand experience with childhood fever was also addressed. Both quantitative and qualitative approaches were used.

RESULTS

Of 1095 (69%) final-year medical students, 756 completed the survey. Many students believe that high fever might cause brain damage, would recommend physical methods and alternate two drugs for fever. Most students do not think that fever has mainly beneficial effects. In Northern Italy, students are less likely to believe that fever might lead to brain damage (OR 0.55, 95% CI 0.33-0.94), and in Southern Italy students are more likely to advise physical methods (OR 1.77, 95% CI 1.22-2.57) and less likely to believe that fever has mainly beneficial effects (OR 0.55, 95% CI 0.39-0.77). History of a relevant personal episode of fever during childhood was not associated with these outcomes.

CONCLUSIONS

Misconceptions about fever are common among final-year medical students in Italy. Cultural factors rather than individually learned traits might underlie these beliefs. Medical students are a promising target for educational interventions to improve childhood fever management.

A continuing professional development imperative? Examining trends and characteristics of health professions education doctoral programs

BACKGROUND

Despite the long-standing faculty development initiatives for improving teaching skills in the health professions, there is still a growing need for educators who are formally trained in educational theory and practice as health professions schools experience dramatic demand and growth. Graduate programs in health professions education (HPE) provide an avenue for health professions' faculty continuing professional development to enhance their knowledge and skills for teaching and curriculum leadership roles. There has been a proliferation of certificate, master's, and doctoral programs in HPE over the last two decades to respond to the growing need for well-prepared faculty educators and program leadership. The purpose of this study was to identify and describe current HPE doctoral programs in United States (U.S.) and Canada.

METHODS

The study first examined doctoral programs in HPE identified in earlier studies. Next, we searched the literature and the web to identify new doctoral programs in the U.S. and Canada that had been established between 2014, when the prior study was conducted, and 2022. We then collated and described the characteristics of these programs, highlighting their similarities and differences.

RESULTS

We identified a total of 20 doctoral programs, 17 in the U.S. and 3 in Canada. Of these, 12 programs in the U.S. and 1 program in Canada were established in the last 8 years. There are many similarities and some notable differences across programs with respect to degree title, admission requirements, duration, delivery format, curriculum, and graduation requirements. Most programs are delivered in a hybrid format and the average time for completion is 4 years.

CONCLUSIONS

The workforce shortage facing health professional schools presents an opportunity, or perhaps imperative, for continuing professional development in HPE through certificate, master's, or doctoral programs. With the current exponential growth of new doctoral programs, there is a need to standardize the title, degree requirements, and further develop core competencies that guide the knowledge and skills HPE graduates are expected to have upon graduation.

Frameworks to Guide Faculty Development for Health Professions Education: A Scoping Review

INTRODUCTION

The authors explored the existence of explicit definitions, guiding competency frameworks, and learning theory to inform health professions education faculty development (FD) programs. The authors analyzed identified frameworks based on thematic focus, scope of targeted faculty, and design structure.

METHODS

A scoping review was used to identify health professions education literature between 2005 and 2020. Frameworks were characterized according to the scope of the faculty targeted and design structure, and then, domains were grouped into topical categories for analysis.

RESULTS

Twenty-three articles met the criteria for data extraction, of which only one (4.3%) described the explicit use of a learning theory and three (13%) included an explicit definition of FD. One (4.3%) used a recognized framework, whereas 12 (52.2%) developed a novel framework based on an existing outline. Ten (43.5%) described de novo framework development. Only three (13.0%) used entrustable professional activities or similar constructs. Five (21.7%) programs targeted multiple health professions, 11 (47.8%) targeted a single health profession, and seven (30.5%) targeted a specific specialty within a health profession. Only two frameworks included a developmental component.

DISCUSSION

Few authors describe an explicit definition, learning theory, or use a pre-established framework when framing their FD programs. The use of entrustable professional activities to structurally link competencies to work practices is also uncommon, as well as the use of developmental structures designed to support progressive FD over time.

Developing entrustable professional activities for doctoral graduates in health professions education: obtaining a national consensus in Iran

BACKGROUND

The number of doctoral programs in health professions education (HPE) is expanding. Entrustable professional activities (EPAs) can be a mechanism to define the expected activities of the HPE doctorate to inform training and assessment processes. The purpose of this study was to develop and reach a consensus on EPAs for HPE doctoral graduates.

METHODS

We used a modified Nominal Group Technique (NGT) to elicit EPA titles followed by two rounds of a modified Delphi survey to seek consensus on the EPAs among groups of experts (HPE doctoral graduates and Board of HPE Examiners members) at the national level in Iran between July 2019 and July 2020.

RESULTS

A total number of 92 initial EPA titles, which emerged from brainstorming in the NGT meeting, was reduced to 27 titles during the clarification process. The final EPA framework consisted of 24 EPA titles with descriptions, arranged in three categories: Research and scholarship (6 EPAs), Educational development (11 EPAs) and Educational management (7 EPAs). All final EPAs scored ≥80% agreement at the national level.

CONCLUSIONS

The proposed EPAs framework can be used to improve the HPE doctorate training and to inform employment decisions. A future international consensus procedure could use these EPA outcomes as a starting point.

Competency-Based Education: Developing an Advanced Competency Framework for Indonesian Pharmacists

Introduction: Pharmacists need to be adaptable, flexible, and capable of advancing their practice to adapt to rapidly changing population health needs. We describe an educational approach to pharmacy workforce transformation in Indonesia through an advanced practice competency framework development using an “adopt and adapt” methodology.

Methods: The competency framework development process comprised a translation phase, an adopt and adapt phase, validation through a nationwide mapping survey, and a completion phase through leadership consensus panels. We conducted a forward-backwards translation of a previously validated Advanced to Consultancy Level Framework (ACLF) to yield the Indonesian Advanced Development Framework (IADF) draft. The subsequent adoption and adaptation process was conducted through a series of consensus panels. We validated the IADF through a nationwide workforce survey. The final phase included leadership consensus panels with the professional leadership body in Indonesia. We analyzed the qualitative data thematically and the quantitative data using a Multiple Correspondence Analysis (MCA) technique.

Results: We identified conceptual challenges in adopting and adapting the existing ACLF, which were addressed by providing a national glossary and concrete examples. A total of 6,212 pharmacists participated in the national workforce survey, of which 43% had <2 years of post-license (post-registration) experience. The MCA results showed that practitioner self-assessment to the IADF could discriminate their career development stages. The results also indicated a four-stage career model (including early years career training). Embedding this model in a structured national training program will enhance the professional workforce development through a more structured career journey.

Conclusions: We describe the first validation of an advanced competency development framework for the pharmacy workforce in a non-Anglophone country, showing the possibility of transnational applicability of this framework. We argue that this methodology can be used in Low and Middle-income countries (LMICs) for the more rapid advancement of pharmaceutical care practice.

Developing a Competency Framework of Interprofessional Occupational Health Team: A First Step to Interprofessional Education in Occupational Health Field

OBJECTIVE

The present study aimed to develop a competency framework for interprofessional collaboration in an occupational health team.

METHODS

This study was carried out in three stages. In the first stage, the viewpoints of different stakeholders on the essential competencies of interprofessional team members in occupational health services (OHS) were assessed. In the second stage, extracted codes were converted into competencies in expert panels. After that, the extracted items were categorized by inductive content analysis approach into competency framework. In the third stage, the content validity of interprofessional competencies in OHS was evaluated.

RESULTS

The competency framework was finalized in six competency domains including prevention, occupational disease management, occupational health assessments, inter-disciplinary and interprofessional collaboration, education, and evidence-based practice and professionalism.

CONCLUSION

The framework could be developed in interprofessional education in OHS based on competency-based education approach.

Development and feasibility testing of an evidence-based training programme for pharmacist independent prescribers responsible for the medicines-related activities within care homes

INTRODUCTION

The UK pharmacists with independent prescribing rights (pharmacist independent prescribers [PIPs]) are authorised to prescribe within their areas of competence. To enable PIPs to provide pharmaceutical care to residents in care homes and assume responsibility for medicines management, a process for development and assessment of competence is required. The aim of this research was to develop a training and accreditation process (training programme) to enable PIPs to operate safely and effectively within care homes.

METHODS

Located in England, Scotland and Northern Ireland across four sites and based on a systematic review, it consisted of four phases: (1) initial stakeholder engagement, (2) uni-professional focus groups and interviews, (3) expert panel consensus and (4) feasibility testing. Four PIPs were trained each to provide pharmaceutical care to 10 care home residents. An expert panel synthesised the evidence at each stage to develop each iteration of the training programme. Content analysis was used throughout.

RESULTS

Differences in baseline knowledge of PIPs required inclusion of a Personal Development Framework and the provision of a mentor. Face-to-face training focussed on managing medicines for a complex older person, minimising prescribing costs and supporting people without capacity. Provision of time to understand local context and develop relationships with care homes and general practitioners was identified as a central requirement. PIPs were assessed for competency via viva. Feasibility testing demonstrated that the derived training programme was acceptable, practical and effective.

DISCUSSION

The model seemed to work, but due to small numbers, larger-scale testing of the training programme is now required.