Conceptualization of Competency-Based Medical Education Terminology in Family Medicine Postgraduate Medical Education and Continuing Professional Development: A Scoping Review

Unveiling the paradoxes of implementing post graduate competency based medical education programs

PURPOSE

Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation.

METHOD

A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards.

RESULTS

Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators.

CONCLUSIONS

Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.

Teaching Observation as a Faculty Development Tool in Medical Education: A Scoping Review

INTRODUCTION

Health professions education often includes teaching observation to inform faculty development (FD) and indirectly improve student performance. Although these FD approaches are well received by faculty, they remain underused and/or underreported, with limited opportunities to receive feedback in workplace contexts. The goal of our study was to map the depth and breadth of education literature on the use of observation of teaching as a tool of professional development in medical education.

METHODS

Following the methodology by Arksey and O'Malley, we conducted a scoping review and searched four databases for articles published in English (final searches in April 2022).

RESULTS

Of 2080 articles identified, 45 met the inclusion criteria. All observation activities were associated with one of the following FD approaches: peer observation of teaching (23 articles, 51%), peer coaching (12, 27%), peer review (9, 20%), and the critical friends approach (1, 2%). Thirty-three articles (73%) concerned formative versions of the observation model that took place in clinical settings (21, 47%), and they tended to be a voluntary (27, 60%), one-off (18, 40%), in-person intervention (29, 65%), characterized by limited institutional support (13, 29%). Both barriers and challenges of teaching observation were identified.

DISCUSSION

This review identified several challenges and shortcomings associated with teaching observation, such as inadequate methodological quality of research articles, inconsistent terminology, and limited understanding of the factors that promote long-term sustainability within FD programs. Practical strategies to consider when designing an FD program that incorporates teaching observation are outlined.

Scholarly practice in healthcare professions: findings from a scoping review

Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.

Advancing the science of health professions education through a shared understanding of terminology: a content analysis of terms for "faculty"

INTRODUCTION

Health professions educators risk misunderstandings where terms and concepts are not clearly defined, hampering the field's progress. This risk is especially pronounced with ambiguity in describing roles. This study explores the variety of terms used by researchers and educators to describe "faculty", with the aim to facilitate definitional clarity, and create a shared terminology and approach to describing this term.

METHODS

The authors analyzed journal article abstracts to identify the specific words and phrases used to describe individuals or groups of people referred to as faculty. To identify abstracts, PubMed articles indexed with the Medical Subject Heading "faculty" published between 2007 and 2017 were retrieved. Authors iteratively extracted data and used content analysis to identify patterns and themes.

RESULTS

A total of 5,436 citations were retrieved, of which 3,354 were deemed eligible. Based on a sample of 594 abstracts (17.7%), we found 279 unique terms. The most commonly used terms accounted for approximately one-third of the sample and included faculty or faculty member/s (n = 252; 26.4%); teacher/s (n = 59; 6.2%) and medical educator/s (n = 26; 2.7%) were also well represented. Content analysis highlighted that the different descriptors authors used referred to four role types: healthcare (e.g., doctor, physician), education (e.g., educator, teacher), academia (e.g., professor), and/or relationship to the learner (e.g., mentor).

DISCUSSION

Faculty are described using a wide variety of terms, which can be linked to four role descriptions. The authors propose a template for researchers and educators who want to refer to faculty in their papers. This is important to advance the field and increase readers' assessment of transferability.

A Sisyphean task: Developing and revising public health nursing competencies

BACKGROUND

Competencies are intended to enhance the public health workforce's skills. Competencies used to evaluate public health nursing (PHN) practice and education have been promoted by several nursing organizations. Having multiple sets of competencies raises questions about redundancies and their usefulness in evaluating PHN, as well as the central question about the value of the competencies themselves.

METHODS

A literature review of psychometric evaluation research of the competencies was performed. Qualitative content analyses were conducted of seven documents: Association of Community Health Nursing Educators', 2000 and 2010 essentials; Quad Council Coalition's 2004, 2011, and 2018 competencies; and the American Nurses Association's, 2013 and the 2021 draft of PHN scope and standards of practice with respect to competency definition, conceptual basis, and use of an established taxonomy.

RESULTS

No psychometric evaluations of the competency sets were found. Textual content analysis revealed inconsistent and or missing competency definitions and theoretical frameworks with competencies proliferating over time. Taxonomy analysis identified minimal competencies at higher complexity levels according to Bloom's revised taxonomy.

CONCLUSIONS

Analyzed competencies lack reliability and validity testing, making assessment difficult for PHN educators and practitioners. Multiple and competing competencies further erode PHN's visibility, even among public health nurses. With unending revisions of PHN competencies and lack of supporting evidence regarding their effect and their integration into education or practice, recommendations for future efforts are offered.

Tensions in describing competency-based medical education: a study of Canadian key opinion leaders

The current discourse on competency-based medical education (CBME) is confounded by a lack of agreement on definitions and philosophical assumptions. This phenomenon impacts curriculum implementation, program evaluation and disrupts dialogue with the education community. The purpose of this study is to explore how Canadian key opinion leaders describe the philosophy and practice of CBME. A purposeful and snowball sample of Canadian key opinion leaders, reflecting diversity of institutions and academic roles, was recruited. A qualitative thematic analysis of semi-structured interviews was conducted using the principles of constructivist grounded theory. A modified integrated knowledge user checking process was accomplished via a national open meeting of educators, researchers, and leaders in postgraduate medical education. Research ethics board approval was received. 17 interviews were completed between September and November 2018. 43 participants attended the open meeting. There was no unified framing or definition of CBME; perspectives were heterogenous. Most participants struggled to identify a philosophy or theory that underpinned CBME. CBME was often defined by key operational practices, including an emphasis on work-based assessments and coaching relationships between learners and supervisors. CBME was articulated as addressing problems with current training models, including failure to fail, rigor in the structure of training and maintaining the social contract with the public. The unintended consequences of CBME included a reductionist framing of competence and concern for resident wellness with changes to the learning environment. This study demonstrates a heterogeneity in defining CMBE among Canadian key opinion leaders. Future work should explore the fidelity of implementation of CBME.

Scoping reviews in medical education: A scoping review

OBJECTIVES

Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities.

METHOD

The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review.

RESULTS

One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal.

CONCLUSIONS

Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.

Using simulation to help healthcare professionals relaying patient information during telephone conversations

BACKGROUND

The purpose of this paper is to describe a development project in which simulation was used to improve the telephone-based conversations between nurses in an emergency department (ED) and physicians from different specialties taking care of acutely ill patients.

METHODS

A needs analysis consisting of observations and interviews was conducted and a one-day simulation-based interprofessional team training course was developed. Observations of phone conversations pre-course, three and six months after the course were conducted in the clinical setting with 20 participants in each point of time. A 14-item evaluation tool was used to record how many information pieces were communicated.

RESULTS

Five courses were conducted for 66 nurses/nurse assistants and 17 physicians. 9 out of the 14 items were reported significantly more after the course. Item that were not reported in the pre-measurement, increased to around 20% reporting three months after the course but then fell to close to 0% again after six months.

CONCLUSIONS

The patterns of retention and decrease of the effect could be an indicator for norms, values and beliefs held by professions about what constitutes their task.