Competency-based Graduate Research Articles

An Ideal System of Assessment to Support Competency-Based Graduate Medical Education: Key Attributes and Proposed Next Steps

Competency-based medical education (CBME) is the future of medical education and relies heavily on high quality assessment. However, the current assessment practices employed by many general surgery graduate medical education training programs are subpar. Assessments often lack reliability and validity evidence, have low faculty engagement, and differ from program to program. Given the importance of assessment in CBME, it is critical that we build a better assessment system for measuring trainee competency. We propose that an ideal system of assessment is standardized, evidence-based, comprehensive, integrated, and continuously improving. In this article, we explore these characteristics and propose next steps to achieve such a system of assessment in general surgery.

Multispecialty Trainee Perspective: The Journey Toward Competency-Based Graduate Medical Education in the United States.

Multispecialty Trainee Perspective: The Journey Toward Competency-Based Graduate Medical Education in the United States.

Incorporating social justice learning into competency-based graduate nursing: A discussion of integrating pedagogies.

The impact of social inequity on the collective health of a society is well documented and, despite decades of research, the problem persists on a global scale. Nurse practitioners are competent to treat the downstream health effects of social inequity, but nursing students may lack the structural awareness to accurately target primary prevention efforts. The authors discuss faculty preparation and pedagogical considerations when incorporating social justice learning into a graduate and post-graduate psychiatric nurse practitioner course. Guided by Walter's Emancipatory Nursing Praxis model, several pedagogical strategies were developed to enhance graduate nursing students' awareness of oppressive and unjust realities in the healthcare setting. Emancipatory pedagogical strategies in competency-based graduate nursing education can enhance the transformative social learning essential for the development of health equity praxis.

Graduate medical education in old age psychiatry: a scoping literature review

Gerontopsychiatry will become increasingly relevant as a discipline for primary care based on current demographic forecasts, destigmatization of mental illness and specific diagnostic and therapeutic developments. Hence, high quality graduate medical training in old age psychiatry is needed. Objectives The goal of this review was to summarize the literature on medical education relevant to residency training in old age psychiatry and to contrast the findings with international developments in competency-based medical education. The authors used the scoping review method of Arksey and O'Malley. The initial search yielded 913 hits. After full text screening, 20 original articles were used for data extraction. The study content was summarized under three categories: trainee recruitment, length and structure of graduate training curricula in old age psychiatry, and learning goals and competencies in old age psychiatry training. Surveys and expert consensus were mostly used as study methods. High-quality clinical training experience with gerontopsychiatric patients and supervision of residents was an important factor for stimulating interest in old age psychiatry. Few studies provided evidence for educational benefit of digital learning and teaching formats and simulation training in old age psychiatry. Overall, there were no studies in old age psychiatry with explicit reference to concepts of competency-based graduate medical education. Clinical rotations and mentoring foster interest of clinical residents in the discipline of old age psychiatry. Systematically introducing clinical rotations in old age psychiatry in general psychiatry residency programs seems necessary to enable residents to gain relevant knowledge and skills. Educational research in old age psychiatry considering patient outcomes seems to be a meaningful next step.

Role of Mentoring in the Era of Competency-based Graduate Medical Education

Role of Mentoring in the Era of Competency-based Graduate Medical Education

Peer Feedback on Collaborative Learning Activities in Veterinary Education

Collaborative learning activities are an increasingly prominent feature of veterinary curricula that have been redesigned to achieve competency-based graduate learning outcomes. This evolution challenges the traditional individualistic approach to veterinary education and necessitates revisions to assessment and feedback practices to ensure constructive alignment. Peer feedback has been widely reported in the medical education literature as a teaching intervention in collaborative learning settings, with learning gains reported for students who receive and provide peer feedback. In this setting, peer feedback has been demonstrated to provide valuable formative feedback on professional behaviors and skills. However, there are very few such reports in the veterinary education literature to date. Barriers to the introduction of this approach can include teacher and student perceptions, and concerns around validity and reliability. This review aimed to provide an overview of current evidence regarding peer feedback on collaborative learning activities in higher education, and to explore opportunities and challenges for the introduction of peer feedback in the context of veterinary education. We contend that early and repeated provision of formative peer feedback can provide an opportunity to scaffold the development of crucial core competencies within veterinary education, including the self-regulated learning skills required to work in collaborative teams, and interpret and act on feedback.

Formal Versus Informal Judgments: Faculty Experiences With Entrustment in Graduate Medical Education.

Entrustment of residents has been formalized in many competency-based graduate medical education programs, but its relationship with informal decisions to entrust residents with clinical tasks is unclear. In addition, the effects of formal entrustment on training practice are still unknown. Our objective was to learn from faculty members in training programs with extensive experience in formal entrustment how formal entrustment relates to informal entrustment decisions. A questionnaire was e-mailed to all Dutch obstetrics and gynecology program directors to gather information on how faculty entrusts residents with clinical independence. We also interviewed faculty members to explore the relationship between formal entrustment and informal entrustment. Interviews were analyzed with conventional content analysis. Of 92 programs, 54 program directors completed the questionnaire (59% response rate). Results showed that formal entrustment was seen as valuable for generating formative feedback and giving insight into residents' progress in technical competencies. Interviewed faculty members (n = 12) used both formal and informal entrustment to determine the level of resident independence. Faculty reported they tended to favor informal entrustment because it can be reconsidered. In contrast, formal entrustment was reported to feel like a fixed state. In a graduate medical education program where formal entrustment has been used for more than a decade, faculty used a combination of formal and informal entrustment. Informal entrustment is key in deciding if a resident can work independently. Faculty members reported being unsure how to optimally use formal entrustment in practice next to their informal decisions.

Breaking Down Barriers to Pharmacy Graduate Education: The Report of the 2017-2018 Research and Graduate Affairs Committee

EXECUTIVE SUMMARY The 2017-2018 Research and Graduate Affairs Committee (RGAC) was given three charges aimed at helping academic pharmacy address barriers that must be overcome by both students and schools to attract, retain, and support the development of a diverse, well-rounded, and successful graduate student population. These charges were (1) identifying teaching methodologies, tools and opportunities that graduate programs can introduce into curriculum to overcome barriers to success of today's and tomorrow's learners; (2) developing a strategy for achieving member support of the 2016-2017 recommended graduate competencies by identifying gaps in and existing examples of courses or opportunities that achieve competency-based pharmacy graduate education; and (3) identifying potential strategies to address identified barriers to pursuing graduate education, especially among under-represented student populations. This report describes attitudes toward and opportunities related to competency-based education in graduation education in colleges and schools of pharmacy, identifies types of tools schools could use to enhance training towards the competency framework developed by the 2016-2017 RGAC, particularly with regards to the so-called power skills, and outlines a role for AACP in facilitating this training. This report also considers a number of barriers, both perceived and real, that potential students encounter when considering graduate training and suggests strategies to understand the impact of and mitigate these barriers. To strengthen competency-based graduate education, the RGAC puts forth two recommendations that AACP develop a toolkit supporting the training of power skills and that AACP should develop or curate programs or tools to support the use of individual development plans (IDPs). The RGAC also puts forth a suggestion to schools that IDPs be implemented for all students. In considering the barriers to pursuing graduate education, the Committee proposes one policy statement that AACP supports the training and development of an increasingly diverse population of researchers at pharmacy schools through active efforts to promote M.S. and Ph.D. education along with Pharm.D. education. Additionally, the Committee provides recommendations that AACP should expand its efforts in career tracking of graduate students to include collection and/or analysis of data that could inform the Academy's understanding of barriers to pursuing graduate education in pharmacy schools, the AACP Office of Institutional Research and Effectiveness should expand upon graduate program data described in the annual Profile of Pharmacy Students report, and finally that AACP should include graduate programs in efforts to increase diversity of students at pharmacy schools.

Characterization and Perceptions of Surgical Clinician Educators: An International Survey

Surgeons worldwide face unique time and practice pressures differentiating them from other types of physicians, specifically as clinician educators (CEs). The purpose of this study is to identify and describe academic surgical clinician educators (SCEs) in international graduate medical education systems, characterize their perceptions of roles, preparedness, and factors affecting job satisfaction and retention, as compared to nonsurgical international CEs. A cross-sectional survey of CEs was conducted June 2013-June 2014 at academic medical centers in Singapore, Qatar, and the United Arab Emirates that adopted competency-based graduate medical education and received accreditation by the Accreditation Council for Graduate Medical Education-International. Two hundred seventy-six (76.3%) of 359 eligible physicians responded; 64 (23.2%) were SCEs. SCEs were predominantly male (80%), less than 50 years of age (83%), with 64% having been in their current position less than 5 years. Overall, SCEs were significantly less confident, as compared to nonsurgical CEs, in aspects of educational programs, including curriculum development, assessment, and mentorship. SCEs spent significantly more time engaged in patient care activities, as compared to nonsurgeon colleagues. There were no significant differences between SCEs and nonsurgical CEs in terms of work-life balance and satisfaction with responsibilities, position, or potential promotion, with most SCEs intending to stay in academic medicine. Academic SCEs working in the international programs reported overall job satisfaction with a desire to remain in academic medicine. However, SCEs have several faculty development needs. International surgical training programs can develop and expand offerings in teaching and education to improve skills and maintain SCE satisfaction and retention, necessary to successfully train the next generation of surgeons.

Proceed With Caution: Implementing Competency-Based Graduate Medical Education.

Proceed With Caution: Implementing Competency-Based Graduate Medical Education.

Global Health Master’s Students: Demographics and Career Goals

The Master of Science in Global Health (MSGH) at Northwestern University is a new competency-based graduate degree program designed to prepare students for careers in global health. The purpose of our research is to determine the market characteristics for this degree, provide student backgrounds that will guide curricular and programmatic improvements, and determine if these students intend to pursue degrees in global health. This study examines survey responses from students admitted to the MSGH program between 2014 and 2015. Survey data were collected by the Northwestern University School of Professional Studies (SPS) as part of the online admissions application process. During the same period, all active students in the program were invited to complete a separate, online survey asking about their global health experience, skills and career goals. Application responses were analyzed using descriptive statistics. Free-text responses from the survey were hand-coded using 10 categorical variables developed through an inductive process. Fifty-four individuals were admitted to the MSGH program within 12 months of its inception. Of these 78% were female and the average age was 36. Of those who responded to questions about current employment, 57% were working in a health science field, 11% in government or public administration, and less than 10% responded in all other categories. Responses from the online survey revealed that most students had some prior global health experiences primarily in the medicine and mission/volunteer categories, 45% and 50% respectively. Responses regarding career aspirations were spread evenly across categories and nearly all students intended to join the global health workforce. Medicine was identified most frequently as a desired field for future careers (30%), followed by government and policy (25%). The wide variety of disciplines represented in students’ previous work histories underscores and supports the interprofessional nature of the field and the workforce. This diversity extends to both educational backgrounds and prior field experience and necessitates pedagogical techniques that can appeal to a wide array of students, particularly a majority female population. Findings regarding desired future employment suggests that career advising will need to adapt to market demands, prioritizing project and program management related careers.

Gender and international clinician educators

ObjectivesTo describe gender differences of international clinician educators (CEs) and leaders, and CEs’ perceptions by gender of preparation, roles, rewards and factors affecting job satisfaction and retention in emerging international...

Innovation in Graduate Education for Health Professionals in Humanitarian Emergencies.

The objective of this report was to show how the Center for Humanitarian Emergencies (the Center) at Emory University (Atlanta, Georgia USA) has trained graduate students to respond to complex humanitarian emergencies (CHEs) through innovative educational programs, with the goal of increasing the number of trained humanitarian workers. Natural disasters are on the rise with more than twice as many occurring from 2000-2009 as there were from 1980-1989. In 2012 alone, 144 million people were affected by a natural disaster or displaced by conflict worldwide. This has created an immense need for trained humanitarian workers to respond effectively to such disasters. The Center has developed a model for educational programming that targets learners along an educational continuum ranging from the undergraduate level through continuing professional education. These programs, based in the Rollins School of Public Health (RSPH) of Emory University, include: a competency-based graduate certificate program (the Certificate) in humanitarian emergencies; a fellowship program for mid-career professionals; and funded field practica. The competency-based Certificate program began in 2010 with a cohort of 14 students. Since then, 101 students have received the Certificate with 50 more due for completion in 2016 and 2017 combined. The fellowship program for mid-career professionals has hosted four fellows from conflict-affected or resource-poor countries, who have then gone on to assume leadership positions with humanitarian organizations. From 2009-2015, the field practicum program supported 34 students in international summer practicum experiences related to emergency response or preparedness. Students have participated in summer field experiences on every continent but Australia. Together the Certificate, funded field practicum opportunities, and the fellowship comprise current efforts in providing innovative education and training for graduate and post-graduate students of public health in humanitarian response. These modest efforts are just the beginning in terms of addressing the global shortage of skilled public health professionals that can coordinate humanitarian response. Evaluating existing programs will allow for refinement of current programs. Ultimately, these programs may influence the development of new programs and inform others interested in this area. Evans DP , Anderson M , Shahpar C , del Rio C , Curran JW . Innovation in graduate education for health professionals in humanitarian emergencies. Prehosp Disaster Med. 2016;31(5):532-538.

Development, Implementation, and Assessment of a Competency Model for a Graduate Public Affairs Program in Health Administration

Competency-based education has become the norm for professional graduate degree programs. This paper describes the development, implementation, and ongoing validation of a competency model designed for a multifaceted public administration program. The model is based on accreditation standards and competencies promulgated by NASPAA and CAHME, and reflects a unique focus on community-engaged pedagogies. A framework consisting of 10 competencies was implemented in 2011–12 and validated through feedback from stakeholders, alumni, field preceptors, and graduates. A two-dimensional matrix of content coverage and expected levels of competency attainment delineates the articulation of competencies, curriculum, and course content, and provides a framework for program evaluation. Multiple methods for evaluating the competency-based graduate health administration program are described. Ongoing efforts to refine courses, the curriculum, and the competency model are discussed in the context of the program’s mission, multiple accreditation standards, assessment of student learning outcomes, and engagement of community stakeholders.

Development of the Anesthesiology Educational Milestones

In the Next Accreditation System, resident performance and progression assessed through educational Milestones will be used as 1 of a number of quality indicators to evaluate the educational effectiveness of residency programs. The Anesthesiology Milestones will be used to measure the success of individual anesthesiology residents in achieving expected goals of training, and the effectiveness of the residency program will in part be evaluated based on aggregated Milestone performance data. Box Members of the Anesthesiology Milestone Working Group Deborah J. Culley, MD, Brigham and Women's Hospital, Chair Neal Cohen, MD, MPH, MS, University of California, San Francisco Steven Hall, MD, FAAP, Northwestern University Catherine Kuhn, MD, Duke University Loraine Lewis, EdD, RD, Executive Director, Anesthesiology RRC Linda Mason, MD, Loma Linda University Steven P. Nestler, PhD, Accreditation Council for Graduate Medical Education Consultant Rita M. Patel, MD, University of Pittsburgh Scott A. Schartel, DO, Temple University Brian Waldschmidt, MD, Resident Member, University of California, San Francisco Mark Warner, MD, Mayo Clinic Margaret Wood, MD, Columbia University College of Physicians and Surgeons

Developing Gerontological Competency: A Curriculum Approach

This study describes a competency-based educational approach to course development, implementation, and evaluation. The course model is presented, including its philosophical base. The authors hypothesized that student participation in a competency-based graduate gerontology course would increase their perceived competency level. Results indicate that students (N = 74 students; 2008–2011) rated their competency skill level as higher at posttest than at the pretest (paired t-tests, p < .01), as measured by the Geriatric Social Work Competency Scale II. In addition, pretest/posttest results on the Myths of Aging checklist and Expectations Regarding Aging survey supported increases of perceived knowledge of older adults at posttest (p < .01). This project illustrates the benefits of organizing and implementing competency-based curriculum so that students are better prepared to work with older adults when they graduate.

DEVELOPING A NEW GRADUATE PROGRAM IN HEALTHCARE MANAGEMENT: EMBRACING THE TRANSFORMATION OF HEALTHCARE MANAGEMENT EDUCATION ON A PATHWAY TO SUCCESS

Within a sea change in the structure and process of providing health services, the field of health administration education has moved decisively and concretely from a teaching-centered model of education based on the assumption that knowledge equals competency to a learning-centered model. The learning-centered, or studentcentered, model is based on the assumption that competency is related to the ability to demonstrate mission- and market-relevant knowledge, skills, values, and attitudes. This article provides a comprehensive, non-prescriptive approach to the development of a new competency-based graduate program in health administration within an urban-based, private university located in the Southwest United States. The authors describe the structure and process used to align the program’s competencies and curricula to the market needs by incorporating the healthcare community’s input. The first part of the article addresses the components of the program development framework, including the determination of a program vision and philosophy and the establishment of a program development group and advisory board. The second part concludes with a discussion of the process used in the selection of a competency model and its application to the course curricula. Keywords: Program Development, Competency, Mission, Advisory-Board, CAHME Accreditation

Educational Perspectives

The morbidity and mortality (M&amp;M) conference offers an opportunity to incorporate principles of quality assurance and patient safety into neonatal practice, while providing a rich opportunity to teach many of the Accreditation Council on Graduate Medical Education (ACGME) core competencies. A historical review highlights the basis of the M&amp;M conference as rooted in the desire to improve physician practice and patient outcomes. Despite the lack of an identifiable, systematic approach to M&amp;M-type conferences among neonatology programs, both the tradition of improving physician practice and patient outcomes by framing suboptimal outcomes as educational opportunities and the dawning of the era of competency-based graduate medical education support the need for neonatology divisions to offer M&amp;M conferences in a contemporary format. Educational models emphasizing quality improvement, patient safety, and incorporation of the core competencies are available to support the goals and objectives of a divisional M&amp;M conference. Setting clear goals, incorporating trained moderators, and having a documentation plan may all contribute to the success of the conference. The addition of an action plan and follow-up component to M&amp;M conferences further credentials this activity as an integral part of overall quality improvement efforts while providing real-life evidence of practice-based learning and improvement and the importance of systems-based thinking.

Master of Public Health Community-Based Practicum

We studied students' perceptions regarding a required 120-hour practicum within a program including service learning and Problem-based Learning. Responses to pre- and postpracticum surveys and a second-year survey were analyzed for 2008 to 2010 graduates. Preceptors' responses regarding students' performance were also analyzed. To assess attainment of public health competencies by analyzing student and preceptor identification of areas for improvement. Basis of study was a 29-item survey regarding competencies before/after practicum completion, and a 27-item postsurvey assessing perceptions of practicum, preceptor, and site. Instruments included a 5-point Likert Scale (1 = strongly disagree/highly ineffective to 5 = strongly agree/highly effective). Practicum experiences are selected from more than 250 community-based partners including government, health systems & not-for-profit agencies. Three first-year student cohorts and preceptors surveyed. Response rates varied across cohorts and instruments. Study focused on satisfaction scores and pre- and postsurvey response differences reported by respondents. Students reported high degrees of satisfaction & value in learning by doing, increased ability addressing real world problems, and commitment to working in the community. Preceptors reported satisfaction with students' competency and ability completing projects. Experiential learning in competency-based graduate public health education derived from Problem-based Learning and service learning shares commonalities and relevance with public health practice, illustrating how Problem-based Learning enhances students' ability becoming self-directed, collaborative, problem-solvers working with communities. Students' service learning ethos is manifested in value attributed to the practicum and community advocacy. Self-assessment of personal and professional development appears enhanced through the practicum experience.

Current State in U.S. Public Health Competency-Based Graduate Education

Calls for educational transformation by education and workforce leaders, as well as both governmental and professional organizations, have been resounding in the United States over the past decade. As a result, increased recognition of outcomes or competency-based education (CBE) has evolved across health professions education and training arenas. In public health specifically, the identification and specification of competencies related to the five long-standing, discipline-based core areas of knowledge in addition to seven cross-cutting interdisciplinary domains are now required for guiding accreditation, curriculum planning, and the measurement of student achievement in both graduate and undergraduate education. Nevertheless, full realization of CBE for potentially enhancing current educational practices, including both learning and assessment methodologies, remains in the early stages of adoption and curricular integration in both public health graduate education and the health professions at-large. This article provides an overview of the influences that have led to the consideration and development of strategies for promoting outcomes-based educational performance and accountability across post-secondary higher education in the US; evolving CBE pedagogy in public health graduate education; and experiences to date regarding success factors, barriers, and challenges encountered with the implementation of competency-based education. Recommendations for furthering educational transformation in public health are also discussed.