Health services research doctoral core competencies

Essential core competencies for health policy graduates: a multi-method consensus type study

BACKGROUND

In light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.

METHODS

The study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel's findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus.

RESULTS

In the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work.

CONCLUSIONS

It is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

Learning Health Systems Research Competencies: A Survey of the Rehabilitation Research Community

OBJECTIVE

The Learning Health Systems Rehabilitation Research Network (LeaRRn), an NIH-funded rehabilitation research resource center, aims to advance the research capacity of learning health systems (LHSs) within the rehabilitation community. A needs assessment survey was administered to inform development of educational resources.

METHODS

The online survey included 55 items addressing interest in and knowledge of 33 LHS research core competencies in 7 domains and additional items on respondent characteristics. Recruitment targeting rehabilitation researchers and health system collaborators was conducted by LeaRRn, LeaRRn health system partners, rehabilitation professional organizations, and research university program directors using email, listservs, and social media announcements.

RESULTS

Of the 650 people who initiated the survey, 410 respondents constituted the study sample. Respondents indicated interest in LHS research and responded to at least 1 competency item and/or demographic question. Two-thirds of the study sample had doctoral research degrees, and one-third reported research as their profession. The most common clinical disciplines were physical therapy (38%), communication sciences and disorders (22%), and occupational therapy (10%). Across all 55 competency items, 95% of respondents expressed "a lot" or "some" interest in learning more, but only 19% reported "a lot" of knowledge. Respondents reported "a lot" of interest in a range of topics, including selecting outcome measures that are meaningful to patients (78%) and implementing research evidence in health systems (75%). "None" or "some" knowledge was reported most often in Systems Science areas such as understanding the interrelationships between financing, organization, delivery, and rehabilitation outcomes (93%) and assessing the extent to which research activities will improve the equity of health systems (93%).

CONCLUSION

Results from this large survey of the rehabilitation research community indicate strong interest in LHS research competencies and opportunities to advance skills and training.

IMPACT

Competencies where respondents indicated high interest and limited knowledge can inform development of LHS educational content that is most needed.

[Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research]

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations.

Development of a learning health system science competency assessment to guide training and proficiency assessment

Introduction

Learning health systems (LHS) science is fundamentally a transdisciplinary field. To capture the breadth of the competencies of an LHS scientist, AHRQ and national experts defined a series of 42 competencies across seven domains that support success. Clinicians, researchers, and leaders who are new to the LHS field can identify and prioritize proficiency development among these domains. In addition, existing leaders and researchers will assemble teams of experts who together represent the LHS science domains. To serve LHS workforce development and proficiency assessment, the AHRQ-funded ACCELERAT K12 training program recruited domain experts and trainees to define and operationalize items to include in an LHS Competency Assessment to support emerging and existing LHS scientists in prioritizing and monitoring proficiency development.

Methods

Sequential interviews with 18 experts iteratively defined skills and tasks to illustrate stage in proficiency, and its progression, for each of 42 competencies in the seven LHS expertise domains: systems science; research questions and standards of scientific evidence; research methods; informatics; ethics of research and implementation in health systems; improvement and implementation science; and engagement, leadership, and research management. An educational assessment expert and LHS scientist refined the assessment criteria at each stage to use parallel language across domains. Last, current trainees reviewed and pilot tested the assessment and the LHS Competency Assessment was further refined using their feedback. The assessment framework was informed by Bloom's revised taxonomy of educational objectives (Anderson and Krathwohl, A taxonomy for learning, teaching, and assessing: A revision of Bloom's taxonomy of educational objectives, 2001) where learning progresses from recalling, defining, understanding, and awareness at the lower levels of the taxonomy, to applying and adopting and finally to creating, designing, and critiquing at the upper levels of the taxonomy. We also developed assessment criteria that could be used for longer term assessment of direct performance. Van der Vleuten et al. (Best Pract Res Clin Obstetr Gynaecol. 2010;24(6):703-719) define longer term direct assessment methods as assessment that occurs over a period ranging from weeks to even years and involves multiple assessment methods and exposure to the learner's work over an extended period.

Results

This experience report describes the content of the LHS Competency Assessment. For each domain and competency, the assessment lists examples of evidence to support expertise at each level of proficiency: no exposure; foundational (awareness/understanding); emerging (early application); and proficient (application with a high level of skill). Trainees begin with baseline standard assessment tables, where they can indicate no exposure or mark the foundational and emerging skills with which they have competence. For domains where foundational and emerging skills have been achieved, users can move on to assessment tables that list evidence of proficiency.

Conclusion

The LHS Competency Assessment offers consistent, graded criteria across the seven LHS domains to guide trainees and mentors to evaluate progress from no experience to foundational knowledge, emerging proficiency, and proficiency. The assessment can also be used to design training and mentoring for those newly exposed to LHS science and for those with key expertise who wish to expand LHS expertise.

Physician Assistant Educator Competencies

The rapid expansion of physician assistant (PA) programs over the past decade has led to a shortage of experienced PA faculty. This has prompted many faculty development initiatives to help provide the skills needed by new faculty making the jump from clinical practice to academia. Faculty development is a key necessity in health professions education because many of the professionals attracted to the educator role are primarily trained as clinicians. Although this issue has been extensively evaluated by our colleagues in medical, nursing, and health education and various faculty development interventions have been implemented, this has not been done in the PA profession. In an effort to correct this, the Physician Assistant Education Association assembled a task force of experienced PA educators and charged them to evaluate the literature on faculty competencies in health professions education and to develop a set of PA educator competencies to help codify the essential knowledge, skills, attitudes, and behaviors that faculty need to be successful in their academic roles.The task force met its charge by engaging in an extensive review of the literature, developing a competency framework and proposed competencies, and soliciting the input of a diverse panel of experts in PA education to vet the proposed competencies. Using the insights and recommendations from the expert panel, the task force refined the competencies-resulting in the framework of PA educator competencies presented in this document.

Understanding the Current Health Services Research Workforce and Maximizing its Future

In 2016, AcademyHealth continued its longstanding efforts to understand the health services research (HSR) workforce, to inform its changing needs through the commissioning of several papers and an invitational conference. This paper serves to summarize the commissioned studies that appear in the current issue of this journal.

Development of Enriched Core Competencies for Health Services and Policy Research

OBJECTIVE

To develop an enriched set of core competencies for health services and policy research (HSPR) doctoral training that will help graduates maximize their impact across a range of academic and nonacademic work environments and roles.

DATA SOURCES/STUDY SETTING

Data were obtained from multiple sources, including literature reviews, key informant interviews, stakeholder consultations, and Expert Working Group (EWG) meetings between January 2015 and March 2016. The study setting is Canada.

STUDY DESIGN

The study used qualitative methods and an iterative development process with significant stakeholder engagement throughout.

DATA COLLECTION/EXTRACTION METHODS

The literature reviews, key informant interviews, existing data on graduate career trajectories, and EWG deliberations informed the identification of career profiles for HSPR graduates and the competencies required to succeed in these roles. Stakeholder consultations were held to vet, refine, and validate the competencies.

PRINCIPAL FINDINGS

The EWG reached consensus on six sectors and eight primary roles in which HSPR doctoral graduates can bring value to employers and the health system. Additionally, 10 core competencies were identified that should be included or further emphasized in the training of HSPR doctoral students to increase their preparedness and potential for impact in a variety of roles within and outside of traditional academic workplaces.

CONCLUSION

The results offer an expanded view of potential career paths for HSPR doctoral graduates and provide recommendations for an expanded set of core competencies that will better equip graduates to maximize their impact on the health system.

Current and Future Demand for Health Services Researchers: Perspectives from Diverse Research Organizations

Objective

The Affordable Care Act and Medicare Access and CHIP Reauthorization Act are changing access to, and delivery of, health care in the United States, with potential implications for the field of health services research (HSR). We therefore investigated employers' perceptions of demand for individuals to conduct HSR, the competencies required for success, and implications for HSR training programs.

Data Source

Interviews conducted in August 2016 with 21 key informants at a range of U.S.‐based HSR organizations.

Study Design

We conducted a semistructured, qualitative, telephone interview study to explore relevant topics.

Data Collection/Extraction Methods

Interviews with respondents were transcribed from recordings and then synthesized by respondent organization type and topic area.

Principal Findings

Most respondents reported recently hiring health services researchers, and most anticipated hiring additional such researchers in the future. Most respondents emphasized the abilities to analyze data, work in teams, and engage with stakeholders. Finally, most respondents recommended that potential recruits gain real‐world experience during their academic training.

Conclusions

Our interviews indicated that current and future demand for health services researchers is strong. They also suggested that, as a field, HSR will continue to draw together individuals from a variety of backgrounds to inform a diverse array of decision makers.

Update on the Health Services Research Doctoral Core Competencies

Objective

To present revised core competencies for doctoral programs in health services research (HSR), modalities to deliver these competencies, and suggested methods for assessing mastery of these competencies.

Data Sources and Data Collection

Core competencies were originally developed in 2005, updated (but unpublished) in 2008, modestly updated for a 2016 HSR workforce conference, and revised based on feedback from attendees. Additional feedback was obtained from doctoral program directors, employer/workforce experts and attendees of presentation on these competencies at the AcademyHealth's June 2017 Annual Research Meeting.

Principal Findings

The current version (V2.1) competencies include the ethical conduct of research, conceptual models, development of research questions, study designs, data measurement and collection methods, statistical methods for analyzing data, professional collaboration, and knowledge dissemination. These competencies represent a core that defines what HSR researchers should master in order to address the complexities of microsystem to macro‐system research that HSR entails. There are opportunities to conduct formal evaluation of newer delivery modalities (e.g., flipped classrooms) and to integrate new Learning Health System Researcher Core Competencies, developed by AHRQ, into the HSR core competencies.

Conclusions

Core competencies in HSR are a continually evolving work in progress because new research questions arise, new methods are developed, and the trans‐disciplinary nature of the field leads to new multidisciplinary and team building needs.

Essential competencies in global health research for medical trainees: A narrative review

INTRODUCTION

Participation in short-term educational experiences in global health (STEGHs) among medical trainees is increasingly accompanied by interest in conducting research while abroad. Because formal training in both global health and research methods is currently under-represented in most medical curricula, trainees are often unfamiliar with the knowledge, attitudes, and skills necessary to design and conduct research successfully. This narrative review identifies essential global health research competencies for medical trainees engaged in STEGHs.

METHODS

The authors searched the literature using the terms global health, competency, research, research methods/process/training, scholarly project, medical student, and medical education/education. Because articles directly addressing global health research competencies for medical trainees were limited, the authors additionally drew on the broader literature addressing general research competencies and global health competencies.

FINDINGS

Articles yielded by the literature search, combined with established guidelines in research ethics and global health ethics, were used to identify six core domains and twenty discrete competencies fundamental to global health research at a level appropriate for medical trainees enrolled in STEGHs. Consideration was given to diverse research modalities, varying levels of training, and the availability of mentoring and on-site support.

DISCUSSION

Research may provide important benefits to medical trainees and host partners. These competencies provide a starting point; however, circumstances at any host site may necessitate additional competencies specific to that setting. These competencies are also limited by the methodology employed in their development and the need for additional perspectives from host partners.

CONCLUSIONS

The competencies identified outline basic knowledge, attitudes, and skills necessary for medical trainees to conduct limited global health research while participating in STEGHS. They may also be used as a basis for curriculum development, assessment, and research capacity development.

Development of the Learning Health System Researcher Core Competencies

OBJECTIVE

To develop core competencies for learning health system (LHS) researchers to guide the development of training programs.

DATA SOURCES/STUDY SETTING

Data were obtained from literature review, expert interviews, a modified Delphi process, and consensus development meetings.

STUDY DESIGN

The competencies were developed from August to December 2016 using qualitative methods.

DATA COLLECTION/EXTRACTION METHODS

The literature review formed the basis for the initial draft of a competency domain framework. Key informant semi-structured interviews, a modified Delphi survey, and three expert panel (n = 19 members) consensus development meetings produced the final set of competencies.

PRINCIPAL FINDINGS

The iterative development process yielded seven competency domains: (1) systems science; (2) research questions and standards of scientific evidence; (3) research methods; (4) informatics; (5) ethics of research and implementation in health systems; (6) improvement and implementation science; and (7) engagement, leadership, and research management. A total of 33 core competencies were prioritized across these seven domains. The real-world milieu of LHS research, the embeddedness of the researcher within the health system, and engagement of stakeholders are distinguishing characteristics of this emerging field.

CONCLUSIONS

The LHS researcher core competencies can be used to guide the development of learning objectives, evaluation methods, and curricula for training programs.

Comparative and cost-effectiveness research: Competencies, opportunities, and training for nurse scientists

BACKGROUND

Comparative and cost-effectiveness research develops knowledge on the everyday effectiveness and value of treatments and care delivery models.

PURPOSE

To describe comparative and cost-effectiveness research; identify needed competencies for this research; identify federal funding; and describe current training opportunities.

METHODS

Published recommended competencies were reviewed. Current federal funding and training opportunities were identified. A federally funded training program and other training opportunities are described.

DISCUSSION

Fourteen core competencies were identified that have both analytic and theoretical foci from nursing and other fields. There are multiple sources of federal funding for research and training. Interdisciplinary training is needed.

CONCLUSION

Comparative and cost-effectiveness research has the opportunity to transform health care delivery and improve the outcomes of patients. Nurses, as clinicians and scientists, are in a unique position to contribute to this important research. We encourage nurses to seek the needed interdisciplinary research training to participate in this important endeavor. We also encourage educators to use the competencies and processes identified in current training programs to help shape their doctoral programs.

Developing a competency-based educational structure within clinical and translational science

In the emerging field of clinical and translational science (CTS), where researchers use both basic and clinical science research methodologies to move discoveries to clinical practice, establishing standards of competence is essential for preparing physician-scientists for the profession and for defining the field. The diversity of skills needed to execute quality research within the field of CTS has heightened the importance of an educational process that requires learners to demonstrate competence. Particularly within the more applied clinical science disciplines where there is a multi- or interdisciplinary approach to conducting research, defining and articulating the unique role and associated competencies of a physician-scientist is necessary. This paper describes a systematic process for developing a competency-based educational framework within a CTS graduate program at one institution.

Advancing knowledge and research: developing a doctoral program in clinical and translational science

In an emerging field, such as clinical and translational science, questions of purpose and educational philosophy are crucial to consider as programs, competencies, and milestones are developed and become generally accepted as broad national standards. This article outlines issues to be taken into account as curricula are planned, implemented, and evaluated. It also discusses how philosophy, competencies, and assessments, including milestones, must be intertwined purposefully, with careful attention paid to the integration of knowledge, skills, and attitudes.

Being global in public health practice and research: complementary competencies are needed

Different sets of competencies in public health, global health and research have recently emerged, including the Core Competencies for Public Health in Canada (CCPHC). Within this context, we believe it is important to articulate competencies for globalhealth practitioners-educators and researchers that are in addition to those outlined in the CCPHC. In global health, we require knowledge and skills regarding: north-south power dynamics, linkages between local and global health problems, and the roles of international organizations. We must be able to work responsibly in low-resource settings, foster self-determination in a world rife with power differentials, and engage in dialogue with stakeholders globally. Skills in cross-cultural communication and the ability to critically self-reflect on one's own social location within the global context are essential. Those in global health must be committed to improving health equity through global systems changes and be willing to be mentored and to mentor others across borders. We call for dialogue on these competencies and for development of ways to assess both their demonstration in academic settings and their performance in global health practice and research.

Perspective: Toward a competency framework for faculty

Today, faculty in academic medicine face challenges in all three mission areas--research, education, and patient care--and require a broad set of competencies to survive in this changing environment. To support faculty and to design assessments that match new expectations, the authors argue that it is essential to capture the full scope of skills, knowledge, and behaviors necessary for a successful faculty member. Thus, it is timely to explore and define competencies for faculty in academic medicine. The authors describe three approaches to identifying faculty competencies. Each reveals diverse but overlapping sets of competency domains, reflecting the breadth of activities expected of today's faculty. To organize these competencies into a coherent framework, the authors propose a model based on a typology of competency. A key feature of the model is the division between occupational competencies, which are largely role-specific, and personal competencies, which are necessary for all faculty. A competency framework also must be developmental, to reflect the growth in skills, knowledge, and behaviors from trainee to expert and to allow for an individual's changing roles over a career. Such a competency framework will inform professional development activities and require assessment of competence. The generation of competencies also will reveal areas of faculty practice that are poorly measured, requiring new tools to be incorporated into existing processes of faculty evaluation. The authors provide general principles to guide the identification of a competency framework for faculty and invite the academic medicine community to engage in further discussion.

Qualitative methods in health services and management research: pockets of excellence and progress, but still a long way to go

The 10-year systematic review of published health services and management research by Weiner et al. (2011) chronicles the contributions of qualitative methods, highlights areas of substantial progress, and identifies areas in need of more progress. This article (Devers, 2011) discusses possible reasons for lack of progress in some areas--related to the under-supply of well-trained qualitative researchers and more tangible demand for their research--and mechanisms for future improvement. To ensure a robust health services research toolbox, the field must take additional steps to provide stronger education and training in qualitative methods and more funding and publication opportunities. Given the rapidly changing health care system post the passage of national health reform and the chalresearch issues associated with it, the health services research and management field will not meet its future challenges with quantitative methods alone or with a half-empty toolbox.

Curricular considerations for pharmaceutical comparative effectiveness research

In the U.S. pharmacoepidemiology and related health professions can potentially flourish with the congressional appropriation of $1.1 billion of federal funding for comparative effectiveness research (CER). A direct result of this legislation will be the need for sufficient numbers of trained scientists and decision-makers to address the research and implementation associated with CER. An interdisciplinary expert panel comprised mostly of professionals with pharmaceutical interests was convened to examine the knowledge, skills, and abilities to be considered in the development of a CER curriculum for the health professions focusing predominantly on pharmaceuticals. A limitation of the panel's composition was that it did not represent the breadth of comparative effectiveness research, which additionally includes devices, services, diagnostics, behavioral treatments, and delivery system changes. This bias affects the generalizability of these findings. Notwithstanding, important components of the curriculum identified by the panel included study design considerations and understanding the strengths and limitations of data sources. Important skills and abilities included methods for adjustment of differences in comparator group characteristics to control confounding and bias, data management skills, and clinical skills and insights into the relevance of comparisons. Most of the knowledge, skills, and abilities identified by the panel were consistent with the training of pharmacoepidemiologists. While comparative effectiveness is broader than the pharmaceutical sciences, pharmacoepidemiologists have much to offer academic and professional CER training programs. As such, pharmacoepidemiologists should have a central role in curricular design and provision of the necessary training for needed comparative effectiveness researchers within the realm of pharmaceutical sciences.

Graduate Attributes for Master's Programs in Health Services and Policy Research: Results of a National Consultation

OBJECTIVE

Our objective was to identify desirable attributes to be developed through graduate training in health services and policy research (HSPR) by identifying the knowledge, skills and abilities thought to be keys to success in HSPR-related careers. We aimed for a framework clear enough to serve as a touchstone for HSPR training programs across Canada yet flexible enough to permit diversity of specialization across and within those programs.

METHODS

OUR APPROACH INVOLVED SEVERAL STAGES OF DATA COLLECTION AND ANALYSIS: a review of literature; telephone interviews with opinion leaders; online surveys of HSPR students, recent graduates and employers; an invitational workshop; and an interactive panel at a national conference. Our final framework was arrived at through an iterative process of thematic analysis, reflection on invited feedback from consultation participants and triangulation with existing competency frameworks.

RESULTS

Our final result was a framework that identifies traits, knowledge and abilities of master's-level graduates who are capable of fostering health system improvement through planning, management, analysis or monitoring that is informed by credible evidence and relevant theory. These attributes are organized into three levels: generic graduate attributes, knowledge related to health and health systems and, finally, attributes related to the application of knowledge for health system improvement. The HSPR-specific attributes include not only an understanding of HSPR theories and methods but also the skills related to the practical application of knowledge in the complex environments of health system decision-making and healthcare policy.

CONCLUSION

Master's-level HSPR training programs should prepare students to pose and seek answers to important questions and provide them with the skills necessary to apply their knowledge within complex decision-making environments.

Conceptual and methodological advances in child-reported outcomes measurement

Increasingly, clinical, pharmaceutical and translational research studies use patient-reported outcomes as primary and secondary end points. Obtaining this type of information from children themselves is now possible, but effective assessment requires developmentally sensitive conceptual models of child health and an appreciation for the rapid change in children's cognitive capacities. To overcome these barriers, outcomes researchers have capitalized on innovations in modern measurement theory, qualitative methods for instrument development and new computerized technologies to create reliable and valid methods for obtaining self-reported health data among 8-17-year-old children. This article provides a developmentally focused framework for selecting child-report health assessment instruments. Several generic health-related quality of life instruments and the assessment tools developed by the NIH-sponsored Patient-Reported Outcome Measurement Information System network are discussed to exemplify advances in the measurement of children's self-reported health, illness, wellbeing and quality of life.

Preparing the health services research workforce

OBJECTIVE

To describe the ways in which investigators are trained for careers in health services research and estimate their number.

DATA SOURCES/STUDY SETTING

Sources describing health services research (HSR) training were consulted and published inventories of HSR training programs were reviewed and 124 training programs were contacted and interviewed to determine the numbers of students and the content of their HSR degree programs.

STUDY DESIGN

Observational study.

DATA COLLECTION

HSR programs listed by AcademyHealth were surveyed and asked for details of enrollments; course content was captured from websites for the remaining programs.

PRINCIPAL FINDINGS

There are over 300 programs that train investigators in health services research in master's and doctoral programs. The number of graduates who become HSRs in any given year is unknown, but approximately 5,000 individuals graduate with skills that would allow them to function in or lead HSR projects and up to 200 fellows are annually trained as potential independent health services researchers.

CONCLUSIONS

The training pipeline for HSR appears to match demand because there are no apparent shortages of skilled workers in the field. There are many forces that are pressuring the field to adapt to technology demands and the increasing need for "translation" of results from research into practice.