Competency Expectations Research Articles

Mind the Gap: The Bumpy Transition From Medical School to Residency.

In 2008, the Accreditation Council for Graduate Medical Education began development of the Next Accreditation System, an assessment strategy based on residents’ achievement of specific milestones within defined competencies as they progress through training. 1 Medical specialties were tasked with creating milestones specific to their training programs. Although similar competency frameworks were used across specialties, these milestones were largely developed in isolation. Not surprisingly, the resulting milestones were ‘‘richly diverse.’’ 2 In several specialties, Level 1 is considered

Rethinking Approach and Avoidance in Achievement Contexts: The Perspective of Dynamical Systems

An integrative model of approach and avoidance goals in achievement contexts is proposed based on the concepts and principles of nonlinear dynamical systems. These goals are conceptualized as self-organizing systems in which information relevant to competence expectancies and perceptions of benefit and threat for the self is integrated with respect to either a single coherent state ( static integration) or 2 conflicting coherent states ( dynamic integration). Mathematical equations depict the emergence of approach and avoidance attractor dynamics from the proposed integration process. The model specifies the conditions under which states of goal involvement will display patterns of resistance (stability), oscillation between approach and avoidance (instability), or reversal (nonlinear change). As a result, this model of approach and avoidance goals equips previous dynamical models of self-regulation with greater social–cognitive substance. It also provides a parsimonious account of achievement motivation and resolves lingering inconsistencies and uncertainties in the achievement goal literature. Moreover, the dynamical systems approach, on which the model is based, provides a heuristic framework for generating new predictions regarding the ebb and flow of approach and avoidance in achievement contexts.

International differences in the management of intracranial aneurysms: implications for the education of the next generation of neurosurgeons.

The publication of the International Subarachnoid Aneurysm Trial rapidly changed the management of patients with subarachnoid hemorrhage. The present and perceived future trends of aneurysm management have significant implications for patients and how we educate future cerebrovascular specialists. To determine present perceived competencies of final-year neurosurgical residents who have just finished their residencies and to relate those to what practitioners from a variety of continents expect of these persons. The goal is to provide a basis for further discussion regarding the design of further educational programs in neurosurgery. A 55-item questionnaire with 33 questions related to competencies and expectations of competency from final-year residents who have just finished residency was completed by 229 neurosurgeons and neuro-radiologists (81 % response rate) of mixed seniority from 45 countries. We used bivariate and descriptive analyses to determine future trends and geographic differences in cerebral aneurysm management as well as the educational implications on the future. More North Americans than those from the rest of the world are of the opinion that graduating residents are presently competent to perform basic cerebrovascular procedures like evacuation of a hematoma and clipping a simple 7-mm middle cerebral artery aneurysm. Extremely few graduating neurosurgical residents anywhere are presently capable of performing endovascular techniques for even the most basic of aneurysms. Most of those surveyed also believe that endovascular and open surgical management of aneurysms should be a part of residency training for all residents (70.4 and 88.7 %, respectively). Our findings have implications for the design of neurosurgical curricula for residents as well as for certification examinations and procedures. Specialty and educational organizations and those responsible for the education of future clinicians who will care for patients with cerebrovascular problems should adjust educational objectives and implement curricula and learning experiences that will ensure that cerebrovascular specialists are capable of providing the best care possible to the patient with an aneurysm, whether that be open surgery or endovascular management. These findings mean that organizations around the world will need to make these adjustments to the education of future specialists.

From the Editor

Following another successful DAA conference, it is fitting that the theme for the June issue of the journal is ‘growing professional competence’. As one of the profession's leading researchers in competency standards, Claire Palermo provides the Editorial. Milosavljevic and colleagues lead the way with innovative research on dietitians in clinical practice. Using qualitative methodology they draw on a strong theoretical framework to expose the stages of professional practice in hospitals and the challenges they present in retaining members. Building effective groups of elders in an ongoing generational fashion is important for the profession to grow and remain effective within the health-care system. MacDonald-Wicks and colleagues then focus on the particular skills required to assist other health professionals in giving weight management advice. Help with developing appropriate nutrition messages appeared to be the main point of issue, bearing in mind that a core competency of dietitians is a translator of nutrition science. In the Public Health domain of practice, Hughes et al. present the findings of a modified Delphi study of competency elements involving 33 identified stakeholders. The outcomes, described as aspirational competency expectations, provide a useful reference for curriculum review in Public Health Nutrition. Beyond entry level competence, Gifford and Snell report on a study examining the barriers and enablers to applying for the Advanced Accredited Practising Dietitian credential. Engaging a mentor and working with colleagues on the application proved to be important considerations. Moving to the professional education setting, Palermo and colleagues report on research involving interviews with new graduates on the topic of competency-based assessment. Following review of themes emerging from these data, they highlight the value of student perspectives in developing forms of competency-based assessment. In a similar fashion, O'Reilly et al. showed that engaging students in the evaluation of approaches to reflective practice strategies will be more helpful in building this skill as they transition to the work environment. Maher and colleagues also focused on student evaluations in their assessment of clinical placements as a component of competency development. They highlighted the need for psychosocial as well as educational development in this transition phase. In contrast, Ash followed a cohort of students across the set of placement experiences showing how the time spent in patient care varied depending on stage of practice and context of placement. Details of this analysis are informative for developing the placement program. In an interesting study from Turkey, Aksoydan and colleagues looked at the historical development of 34 Nutrition and Dietetic programs and found an agreed emphasis on practical placements and work-related skills development. Peer learning is a type of activity on placement. From Ireland, Lynam and colleagues report on a pilot study involving four clinical sites in which a framework for developing the 2:1 model was developed and described. Further research in this area will be useful in adapting this approach. Professional competence also involves the use and development of methodologies in dietetics research and practice. This includes methods that enable assessment of body composition. The first methodology paper by Anderson et al. compared the use of bioelectrical impedance to deuterium dilution for assessment of total body water, and reported on the significance of observed bias. Whatever the research entails, moving to publication is an important next step. Disappointingly, Miller et al. found that the publication rate for abstracts of work presented at DAA national conferences between 2006 and 2009 was particularly low. Partnerships with academics appeared to be a useful strategy in moving forward. Let's hope the materials in this issue provide motivation to improve that scenario.

Education and simulation training of pediatric intensive care unit nurses to care for open heart surgery patients.

Providing appropriate education for nurses working in the pediatric intensive care unit (PICU) to develop and update the skill sets and knowledge required to care for infants and children with congenital heart disease (CHD) is a challenge. We provide care to children with a variety of congenital heart defects that require medical care and surgical corrections. In the extreme circumstance, we provide extracorporeal membrane oxygenation to those children who require extracardiac support postoperatively. Our program deals with a mean of about 150 cases annually that require surgical correction, in addition to the medically managed patients with CHD. The hospital-based simulation center opened in 2010. It provides high-fidelity simulation to enhance current medical and nursing education. Patient scenarios are created on the basis of real patient cases, maintaining the realistic details of the disease and injury processes essential to provide the pertinent learning points of each case. Shortly after the simulation center opened, the PICU educator inquired about the process to provide PICU nurses an opportunity to learn about pediatric open heart surgery patients at the simulation center. The inherent challenge within our PICU is that we have 32 nurses with various skills sets and experiences who must be able to provide care for all patients within our unit, including children with CHD. At that time, 7 PICU nurses were ready to learn how to provide nursing care to children who have undergone open heart surgery. This state of readiness is detailed later. A classroom format was used to present the material, which addressed identification of defects, along with medical and nursing management. This classroom training was followed by a 4-hour simulation session, wherein these nurses participated in 2 patient scenarios. Clinical objectives (Table 1) were reviewed and reinforced to define what needed to be learned and to ensure that learning occurred. Following this simulation training, each nurse was assigned to admit a pediatric open heart patient with an experienced nurse present to reinforce the prior learning.

Consensus on the core functions of the public health nutrition workforce in Australia

AbstractAimTo assess consensus among public health nutrition workforce development stakeholders on public health nutrition workforce core functions, and the level of competency attainment required to perform each function in different practice jurisdictions.MethodsA modified Delphi study involving three iterative survey rounds among a purposively sampled expert panel of 33 public health nutrition workforce development stakeholders. Surveys tested panellist ratings of a listing of 50 function statements derived from the literature, across two survey rounds (rounds 1 and 2), with feedback between rounds. Rounds 2 and 3 assessed panellist ratings of the level of competency attainment required to perform functions across pre‐defined district, provincial and national practice jurisdictions. An arbitrary consensus cut‐off of >50% was applied with <10% change between rounds interpreted as agreement stability.ResultsEighteen of a total list of 50 functions were rated as ‘core’ by a majority (>50%) of panellists, with six categorised as analytical, five as capacity building and eight as intervention management functions. The level of competency attainment required to effectively perform these 19 core functions increased consistently as the jurisdiction of practice increased in population coverage (district < provincial < national).ConclusionsPublic health nutrition workforce development stakeholders in Australia agree that there are a number of consistent core functions of the public health nutrition workforce that help define the work of public health nutritionists. They also recognise that the competency expectations for practice vary in different practice jurisdictions. The results provide an empirical basis for prioritising and designing future workforce development targeting specific practice jurisdictions.

Recruiting the competent lobbyist: Career options and employer demands in Germany

Germany likely employs Europe’s largest national lobby labor force. This article presents a comprehensive study of German lobbyists’ workplaces and employer expectations of competencies. It provides insights into emerging requirements for a qualified workforce in a diversified job market. Drawing on multiple sources of statistics, surveys and cases, the first section examines staffing and entry routes for the main employer types – associations, corporations and consultancies. The job market offers a broad range of career options. This includes an emerging set of junior training programs. German employers have devised fully paid apprenticeship models as structured practical learning schemes where rotating workplace assignments alternate with seminar learning. Some employers partner in training alliances. Traineeships are tailor-made and unregulated, but their existence points to a growing employer interest in formally developing a talent base and professionalism. The second section offers a job market snapshot based on 189 advertisements from 2012 to 2014. Job ads can be assumed to be an objective measure of employers’ articulated intentions and expectations for a quality pool of applicants. The survey tabulates preferences for experience, academic degrees, knowledge areas, personal, social and method competencies, and specific political expert skills. Results demonstrate a complex interplay of qualifications and requirements. Ads also show great variety and ambiguity, suggesting that lobbying lacks standardized job classifications and a stable common vocabulary. Findings show that organizational settings influence task and competency combinations expressed in job ads. While all employers appear to follow similar recruiting patterns in regard to some qualifications, they also differ. For example, associations and businesses place more emphasis on policy concepts, organizational participation, coordination, administration and direct representation than do consultancies, while the latter stress advisory roles and strategizing. Corporations get less involved in campaign advocacy. Associations focus on members. Consulting firms tend to recruit younger, less experienced staff, and to less often request domain knowledge. Highlighting commonalities and differences, this article may help stimulate discussion on explicating employers’ competency-based human capital management and recruiting practices. The results may help develop guidelines for apprenticeship schemes, continuing education, organized efforts of professional bodies and university curricula.

The survey of expectations for core competency of geriatric clinical nurse specialist among medical staffs in the department of geriatrics

Objective We aimed to investigate the expectations for core competency of geriatric clinical nurse specialists and its influencing factors. Methods The questionnaire survey was conducted among 76 medical staff with self designed questionnaire and general demography data in the Department of Geriatrics. Results 76 geriatric medical staff thought geriatric clinical nurse specialists should get bache-lor's degree (46.1%), with 5 to 10-year working experience (47.4%). Respondents with different ages, profes-sional titles and post showed different expectation levels for geriatric clinical nurse specialists. Conclusions The medical staff from department of geriatrics considered that a geriatric clinical nurse specialist should work for more than five years, with bachelor's degree or above, should have education, research, strong communication skills and team work skills, strong physical ability, the capacity of discovery of the clinical problems and pharmacology knowledge. Key words: Department of geriatrics; Clinical nurse specialist; Core competency; Survey

Development of an Innovative Tool to Assess Student Physical Therapists’ Clinical Reasoning Competency

BACKGROUND AND PURPOSEIn the recent decades, the role of physical therapists (PTs) has been changing with an ever-increasing autonomy,1 accountability,2,3 and public expectation of professional competency.4 Since clinical reasoning is a vital component of professional competency,5 the American Physical Therapy Association has specified clinical reasoning as an educational outcome for graduates of physical therapist education programs.6 The importance of clinical reasoning in physical therapist education demands discipline-specific assessment tools7 and a thorough assessment system that incorporates different types of assessments.8Miller9 proposed a pyramidal framework, which divides clinical assessment into 4 hierarchical levels-knows, knows how, shows how, and does-in a bottom-up sequence. Rethans et al10 redefined the last 2 levels and labeled them as competency and performance, respectively. Miller's9 pyramid with the modified definitions provides a theoretical framework to form a comprehensive system for assessing the clinical reasoning of student physical therapists (SPTs). Figure 1 illustrates the assessment system, including the definition and testing environment of each level. Paper-based examinations are means to assess cognitive knowledge11 and can be used to test students' clinical reasoning at the bottom 2 levels. The Physical Therapist Clinical Performance Instrument: version 200612 (PT CPI: version 2006), on the other hand, serves as a tool to assess students' clinical reasoning at the performance level. To date, no tool has been designed to assess the competency level-what an individual is capable of doing in a controlled representation of professional practice.10 The lack of competency assessment makes the assessment system incomplete.Standardized patients have been used in examinations to provide simulated clinical encounters,9 which is a requirement for testing competency.10 For students who do not perform well on standardized patient examinations, their underlying problems have been categorized into 3 types: technique, cognitive, and noncognitive, with clinical reasoning and knowledge deficits identified as the cognitive problems.13 Identifying students who struggle with standardized patient examinations due to deficits in clinical reasoning can be a challenge, because clinical reasoning is a nearly invisible process14 that is not easily accessible or assessable. Therefore, the invisibility issue of clinical reasoning needs to be addressed in order to make standardized patient examinations a more suitable testing environment to assess students' clinical reasoning competency. Qualitative researchers adopted a method when studying the mostly invisible clinical reasoning process.15-17 The method required the research participants to encounter with clinical cases and verbalize their thinking underpinning the encounter, either concurrently (during the encounter) or retrospectively (after the encounter). Ericsson and Simon18 supported the use of verbal reports, particularly the concurrent and immediate retrospective ones, as a valid source of information about cognitive processes. Thus, combining the think aloud method with a standardized patient examination is theoretically sound in making the mostly invisible clinical reasoning visible and accurately represented in a simulated testing environment. Despite the theoretical soundness, scarce evidence is available pertaining to the combination. Pintz19 developed a standardized patient examination for assessing nurse practitioner students' diagnostic reasoning. Each student was required to work with a standardized patient alone, with the performance videorecorded for grading. The researcher reported occasions that the standardized patient had to prompt the students to think aloud. However, there was no description that the standardized patients were trained to do so. The lack of training might have made the prompting inconsistent. …

Interprofessional education: Growing focus on preparing students for team-based care

“The students will be judged on whether they seek information from the right professions at the right time to make better patient care decisions,” Lucinda Maine, BSPharm, PhD, Executive Vice President and CEO of AACP, told Pharmacy Today. The game is just one example that highlights the growing focus on interprofessional education (IPE) in pharmacy education. Through IPE, pharmacy schools are teaching students how to work with other medical professionals, such as physicians and nurses, to prepare them for team-based care— whether in a hospital, integrated health system, or community practice setting. And for the first time, accreditors from almost all health professions, including pharmacy, are requiring IPE in their curriculum. Final 2016 standards from the Accreditation Council for Pharmacy Education (ACPE) will be published early next year and are expected to lay out significant changes. The standards state that pharmacy curricula must prepare all students with the skills to provide entry-level, patient-centered care in a variety of practice settings as contributing members of interprofessional teams. “The fact that now accreditors are requiring it is a big change,” Peter H. Vlasses, PharmD, DSc (Hon), BCPS, FCCP, Executive Director of ACPE, told Today. Vlasses said it’s the first time almost all of medicine includes IPE competency expectations in standards. “So now instead of accreditors being blind to this like they were in the past, the stars are lining up so that professionals all agree that we need to do this and we need to work together,” said Vlasses.

Career Plans and Perceptions in Readiness to Practice of Graduating General Surgery Residents in Canada

Overall, 25% of American general surgery residents identified as not feeling confident operating independently at graduation, which may contribute to 70% pursuing further training. This study was undertaken to identify intended career plans of general surgery graduates in Canada on a national level, and perceived strengths and weaknesses of training that would affect transition to early practice. Questionnaires were distributed to graduating general surgery residents at a Canadian national review course in 2012 and 2013. Data were analyzed for overall trends. Overall, 75% (78/104) of graduating residents responded in 2012 and 53% (50/95) in 2013. Greater than 60% of respondents were entering a fellowship program upon graduation (49/78 in 2012 and 37/50 in 2013); the most common fellowship choices were minimally invasive surgery (24% in 2012 and 39% in 2013) or surgical oncology (16% in 2012). Most residents reported that they were completing subspecialty training to meet career goals (64/85 overall) rather than feeling unprepared for practice (0/85 overall). Most residents planned on practicing in urban centers (54%) and academic hospitals (73%). Residents perceived a need for assistance for laparoscopic adrenalectomy, neck dissection, laparoscopic splenectomy, laparoscopic low anterior resection, groin dissection, and thyroidectomy. An overwhelming majority of general surgery graduates plan to pursue fellowship training to meet career goals of working in urban, academic centers, rather than a perceived lack of competence. It is vital to describe operative competency expectations for residents and to promote a variety of practice opportunities following graduation.

Status problem and expectations of competence: a challenging path for teachers

Complex Instruction (CI) is a cooperative learning approach, which aims at improving the equal status interaction among students working in groups who may be at different academic and social levels. Based on an ethnographic research, the article examines how a group of Italian primary school teachers understand the status problem and how the finding from this research demonstrates a change in their expectations of competence through using CI. This research analyses to what extent these teachers meet the original goal of achieving greater equity, as well as discussing implications for teachers' professional development.

Aligning Expectation and Reality About IT Career Preparation: Perception of Job Competencies by Students, New Professionals, and Employers

The skills that individuals need to compete in the knowledge economy place the emphasis on improving science, technology, engineering and mathematics (STEM) education in general and information technology (IT) education in particular. Understanding the underlying use of information and communication technologies (ICT) in all aspects of life sets the educational agenda that guides IT technician education and the future skill sets of IT workers. Prior research has focused on the value of undergraduate IT degrees but not enough is known about the impacts that IT education may have on student employment success and the labor market. This study examines current IT students’ job competency expectations provided in IT college curricula, identifies the actual job competencies new IT professionals need, and describes the alignment between these competencies and the staffing needs reported by northwest Florida employer job postings. This paper presents preliminary findings of the four-year, National Science Foundation Advanced Technological Education (NSF ATE) project, Assessing Information Technology Educational Pathways That Promote Deployment and Use of Rural Broadband in which IT technician education is viewed from the perspective of the student and new professional in an effort to examine how IT workers meet the needs of employers.

Code blue: overcoming the fear.

Code blue: overcoming the fear.

Promoting medical students' reflection on competencies to advance a global health equities curriculum.

BackgroundThe move to frame medical education in terms of competencies – the extent to which trainees “can do” a professional responsibility - is congruent with calls for accountability in medical education. However, the focus on competencies might be a poor fit with curricula intended to prepare students for responsibilities not emphasized in traditional medical education. This study examines an innovative approach to the use of potential competency expectations related to advancing global health equity to promote students’ reflections and to inform curriculum development.MethodsIn 2012, 32 medical students were admitted into a newly developed Global Health and Disparities (GHD) Path of Excellence. The GHD program takes the form of mentored co-curricular activities built around defined competencies related to professional development and leadership skills intended to ameliorate health disparities in medically underserved settings, both domestically and globally. Students reviewed the GHD competencies from two perspectives: a) their ability to perform the identified competencies that they perceived themselves as holding as they began the GHD program and b) the extent to which they perceived that their future career would require these responsibilities. For both sets of assessments the response scale ranged from “Strongly Disagree” to “Strongly Agree.” Wilcoxon’s paired T-tests compared individual students’ ordinal rating of their current level of ability to their perceived need for competence that they anticipated their careers would require. Statistical significance was set at p < .01.ResultsStudents’ ratings ranged from “strongly disagree” to “strongly agree” that they could perform the defined GHD-related competencies. However, on most competencies, at least 50 % of students indicated that the stated competencies were beyond their present ability level. For each competency, the results of Wilcoxon paired T-tests indicate – at statistically significant levels - that students perceive more need in their careers for GHD-program defined competencies than they currently possess.ConclusionThis study suggests congruence between student and program perceptions of the scope of practice required for GHD. Students report the need for enhanced skill levels in the careers they anticipate. This approach to formulating and reflecting on competencies will guide the program’s design of learning experiences aligned with students’ career goals.

Physical examination instruction in US pharmacy curricula

ObjectiveCompare physical examination instruction and competency expectations between US pharmacy schools. MethodsPharmacy Practice Department Chairs or their equivalents at all US pharmacy schools were surveyed regarding physical exam instruction and evaluation within their respective curricula. Opinions were also gathered regarding physical exam competency expectations and the need to formally evaluate this skill prior to graduation and for purposes of US licensure and federal healthcare provider recognition. The survey instrument was pretested prior to dissemination. ResultsThe survey response rate was 56%. Instructional and assessment methods used in teaching and evaluating physical exam skills were similar among responding US pharmacy programs. However, there is variability in the extent of physical exam instruction and evaluation as well as opinions related to physical exam competency expectations prior to graduation and for purposes of US pharmacy licensure and federal healthcare provider credentialing. Overall, 83% of programs require students to demonstrate correct exam techniques via a competency exam; however, only 52% of schools require students to apply physical findings to therapeutic decision-making. Respondents from new schools were more likely to support formal competency evaluation of physical exam skills via objective structured clinical exam for purposes of US licensure and healthcare provider credentialing compared to established schools (p < 0.05). ConclusionDifferences in competency expectations and the extent of physical exam instruction and evaluation in US pharmacy schools illustrate the need for a minimum national standard for this pharmacy practice skill.

Competency expectations for property professionals in Australia

Purpose– The aim of this paper is to identify the competency expectations for property professionals in Australia. It further discusses differences in competency expectations between property professionals who have different professional backgrounds, such as valuers or non-valuers, and property professionals who work in different sectors or different-sized companies and who have differing amounts of experience. The competencies identified in this paper include knowledge areas, skills and attributes.Design/methodology/approach– This paper presents the research findings of a questionnaire survey sent to Australian Property Institute members, which aimed to gather Australian property professionals' views on the knowledge, skills and attributes required to perform their roles effectively. The percentage of the respondents who provided different choices of given answers for each of the 31 knowledge areas, 20 skills and 21 attributes was identified and discussed. The professional backgrounds of the respondents were also identified to see whether these impact on competency expectations for property professionals. Content analysis was used to analyse written comments collected in the questionnaire.Findings– The most important categories of knowledge, skill and attribute for Australian property professionals are valuation, effective written communication and practical experience, respectively. The least important are international real estate, second language and creativity. Knowledge of rural valuation is very important in Australia, although this has not been mentioned in previous studies. Professional backgrounds have a large influence on Australian property professionals' views on knowledge requirements, but less so on skills and attributes.Practical implications– The findings of this paper can be used as guidance for property professionals in their professional development plan. In addition, property course providers can use the research findings of this paper to inform their curriculum development and redesign.Originality/value– This project is the first to identify the comprehensive competency expectations of property professionals as a whole in Australia. At the same time, it identifies differences in the competency expectations of property professionals who have different professional backgrounds. Similar types of study have been conducted in the UK, the USA, Hong Kong and New Zealand but not yet in Australia. An understanding of the knowledge, skills and attributes required for property professionals is important for continuing professional development, curriculum development and the redesign of relevant property courses in order to maintain performance and competitiveness in the property sector.

Aspirational competency expectations for public health nutritionists in Australia: A consensus study

AbstractAimTo assess consensus among public health nutrition (PHN) workforce development stakeholders on the competencies required for effective PHN practice in the Australian workforce context.MethodsA modified Delphi study involving two iterative survey rounds among an expert panel of 33 Australian PHN workforce development stakeholders. Surveys tested panellist ratings (essential, useful, irrelevant) of a listing of 143 competency elements derived from the literature and existing competency standards, across two survey rounds, with feedback between rounds. An arbitrary consensus cut‐off of 67% was applied with &lt;10% change between rounds or 100% agreement interpreted as agreement stability.ResultsA total of 109 competency elements from the total list of 143 were rated as essential above the consensus cut‐off, representing 76% of the original list. Thirty‐three (33) elements were rated as essential by 100% of panellists. Approximately 90% or more of the competency elements tested were retained using the 67% cut‐off across nutrition science, nutrition communication, professional communication, capacity building and intervention management competency units. Competency elements rated as essential beyond the consensus cut‐off concentrated in the practice competency units of nutrition assessment, monitoring and surveillance, capacity building, and intervention management.ConclusionsThe results provide an empirical basis for future nutrition curriculum renewal and workforce development innovations and challenge the assumption that existing dietetic workforce preparation based on meeting entry‐level competencies is adequate for community and PHN practice.

The Ironic Costs of Performing Well: Grades Differentially Predict Male and Female Dropout From Engineering

Stereotype threat may not only affect academic performance and persistence but also the relationship between the two variables. An analysis of the trajectories of 2,397 individuals who began majors in engineering shows a gender gap in graduation rates for those with high and average GPAs. Survey data (N = 455) furthermore highlight that good grades, while reducing academic self-doubt, ironically accentuate female students' social discomfort, and that after dropout, women are more likely than men to show signs of disidentification. For a minority that is met with negative competence expectations, good intellectual performance is no guarantee for persistence.

Managing to Stay in the Dark: Managerial Self-Efficacy, Ego Defensiveness, and the Aversion to Employee Voice

Soliciting and incorporating employee voice is essential to organizational performance, yet some managers display a strong aversion to improvement-oriented input from subordinates. To help to explain this maladaptive tendency, we tested the hypothesis that managers with low managerial self-efficacy (that is, low perceived ability to meet the elevated competence expectations associated with managerial roles) seek to minimize voice as a way of compensating for a threatened ego. The results of two studies support this idea. In a field study (Study 1), managers with low managerial self-efficacy were less likely than others to solicit input, leading to lower levels of employee voice. A follow-up experimental study (Study 2) showed that: (a) manipulating low managerial self-efficacy led to voice aversion (that is, decreased voice solicitation, negative evaluations of an employee who spoke up, and reduced implementation of voice); and (b) the observed voice aversion associated with low managerial self-efficacy was driven by ego defensiveness. We discuss the theoretical and practical implications of these findings, as well as highlight directions for future research on voice, management, and leadership.